Burns 29 (2003) 381–384 Case report Proliferative “crescentic” glomerulonephritis in a burned patient Mustafa Deveci a,∗ , Mehmet Bozkurt a , Önder Öngürü b , Mustafa Sengezer a a Department of Plastic and Reconstructive Surgery and Burn Centre, Gülhane Military Medical Academy, 06018 Etlik, Ankara, Turkey b Department of Pathology, Gülhane Military Medical Academy, Ankara, Turkey Accepted 2 December 2002 Abstract Acute renal failure is one of the major complications of burn and it is accompanied by a high mortality rate. However, acute glomeru- lonephritis due to major burn have not been reported in burn literature. We report a case of crescentic glomerulonephritis which began at 27 days postburn. In this case glomerulonephritis may be due to infection probably pseudomonas or enterococus sepsis. We also felt that imipenem may be contributed the formation of glomerulonephritis. © 2003 Elsevier Science Ltd and ISBI. All rights reserved. 1. Introduction Extensive cutaneous burn produces local changes which may cause general effects involving each system of the body [1]. Changes in blood volume, fluid exchanges and drug interactions may result in renal damage [1–3]. Usually acute renal failure is one of the major complications of burn and it is accompanied by a high mortality rate. The incidence of acute renal failure (ARF) in severely burned patients ranges from 1.3 to 38% and this complication has always been associated with high mortality rate, which is between 73 and 100% [2].The pathophysiologic mechanism may be related to filtration failure or tubular dysfunction. However, acute glomerulonephritis due to major burn have not been reported in burn literature. Necrotizing (crescentic) glomerulonephritis is a histolog- ical type that has been recognised for over 50 years [4]. It is associated with many clinical conditions such as polyarteritis nodosa, infective endocarditis, Wegener’s granulomatosis, idiopathic pulmonary hemorrhage (Goodpasture syndrome), the Churg–Strauss syndrome and relapsing polychondritis. It has been regarded as a severe progressive form of renal disease with an extremely poor prognosis [4]. Herein, we report a case of crescentic glomerulonephritis which began at 27 days postburn and the possible mechanisms are also discussed. ∗ Corresponding author. Tel.: +90-312-304-5401; fax: +90-312-304-5412. E-mail address: mdeveci98@yahoo.com (M. Deveci). 2. Case report A 22-year-old man who was injured by flame burn was admitted to our burn centre. Physical examination revealed full-thickness burn injury involving 46% of TBSA and 32% was full thickness burn. On admission central catheter was inserted via femoral vein (the groin not being burned). A fo- ley catheter was inserted, and urine output was maintained at >75 ml/h. He sustained full-thickness burn to anterior part of neck, anterior chest, both forearms and to both legs. From admission, he remained haemodynamically stable and he did not have any renal problems. Excision was delayed because the patients general condition was poor and admitted at 5 day postburn. Prior surgery second generation sefalosporin was stared. After the patients general condition had been improved excision and auto-homografting was performed to 32% full thickness burn surface at 7 days postburn. He was normotensive and did not have any urinary abnormalities. At 12 days postburn, the patient developed fever 39.5 ◦ C. Swab culture, blood, urine cultures were taken. Central line was withdrawn and the tip catheter was sent to microbiology laboratory for analysis. Blood culture revealed staphylococ- cus (coagulase negative) and was sensitive to ciprofloksasin and amikacin hence they were started. The patient responded and within 3 days his temperature returned to a baseline level of 37.2 ◦ C. Amikacin and ciprofloksasin were ceased at 19 days postburn and blood samples sent to microbiol- ogy laboratory for analysis and blood culture was negative. At 21 days postburn the patient’s general condition dete- riorated and developed high spiking fever of 38.7 ◦ C with the increase in his neutrophilic leucocytosis. Swab, blood 0305-4179/03/$30.00 © 2003 Elsevier Science Ltd and ISBI. All rights reserved. doi:10.1016/S0305-4179(03)00012-3