Necrotizing fasciitis can present with concomitant
acute kidney injury. The etiology of
acute kidney injury is often multifactorial; potential sources include volume depletion,
abdominal compartment syndrome,
rhabdomyolysis, and acute tubular
necrosis (which may be related to hemodynamic instability, medications, or
sepsis/
infection). Kidney injury, defined via changes in serum
creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with
necrotizing fasciitis who endured 31 consecutive days of complete
anuria. His serum
creatinine decreased over this interval without the use of extracorporeal
hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume
resuscitation. The patient's own convective clearance was substantial enough to maintain a modest
creatinine clearance of 15 ml/min during sustained
anuria. Our case emphasizes the importance of employing the
creatinine, estimated glomerular filtration rate, and urine output portions of the
Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage (RIFLE) criteria in assessing the severity of kidney injury. It further reinforces the imperfection in using serum
creatinine as a primary measure of glomerular filtration rate.