THE RENAL LESIONS IN EXTENSIVE CUTANEOUS BURNS

Abstract

The literature dealing with the pathologic anatomy of the kidneys following severe cutaneous burns is extensive. Descriptions of the gross lesions were published by Cumin¹ in 1823 and by Long² in 1840, but these are chiefly of historical interest. The modern concept of the renal changes associated with burns began with Wertheim's³ description in 1867 of his findings in dogs, supplemented in 1868 by study of a severely burned patient. Utilizing the observations of Schultze⁴ (1865) on the degenerative changes in red blood cells on a heated microscopic stage, Wertheim described crystals of blood pigment in the renal tubules in both his experimental animals and patients. The parenchymatous changes he referred to as a form of "Bright's kidney." The presence of hemoglobin in the renal tubules after severe burns was confirmed by Ponfick⁵ (1876), Fraenkel⁶ (1889) and others. Ponfick also described "intensive congestion of