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Augmented Renal Clearance: When Kidneys Work Overtime

After a severe burn injury, the body can react unexpectedly.

One change is that the kidneys may start working more than usual — a condition called augmented renal clearance (ARC). This can affect how medications work in the body. Knowing about ARC can help patients and families understand why medication plans might shift during recovery. 


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What is Augmented Renal Clearance?

Augmented renal clearance means the kidneys are clearing — or removing — medications from the body faster than usual. This matters because medications often need to stay in the bloodstream at a certain level to work properly. When the kidneys work too fast, that doesn’t always happen. 

This can lead to:

  • Medications not working as well as expected 

  • Needing higher or more frequent doses 

  • Delays in improvement or healing 

Why It Happens After a Burn Injury

After a serious and large surface area burn, the body responds with a strong healing reaction. That includes changes in blood flow, hormone levels, and kidney function. It’s common for burn patients to receive large amounts of fluids, which also affects how the kidneys work. 

This response is part of the body’s effort to heal, but it does mean medication plans may need to be adjusted. 

Together, these changes can:

  • Speed up how quickly the kidneys filter the blood 

  • Remove medications before they have a chance to work  

What It Means for Medications

If a medication isn’t staying in the body long enough, it may not work. This is especially important for antibiotics, which must be at certain blood levels to fight infections. 

ARC may require: 

  • Higher doses of some medications 

  • More frequent dosing 

  • Blood level checks to make sure the medication is working 

This doesn’t mean something is wrong — just that the body works differently than expected. 

How ARC is Managed

Doctors and pharmacists often track how medications are working by: 

  • Testing kidney function 

  • Monitoring medication levels in the blood 

  • Adjusting the medication plan as needed 

If a patient isn't improving or needs a higher dose than expected, ARC may be the reason, and the care team will adjust accordingly. 

How Common Is This?

Augmented renal clearance is very common in patients with large surface burns.  

What You Should Know

ARC is temporary and often improves as the body heals

Medication plans may change, and that’s normal

Extra testing or blood draws may be done to check levels

The care team is watching closely to make sure medications are working

If you have questions about why a dose changed or a medication was added, ask — your burn care team is there to help. 

Disclaimer 

This information is not a substitute for professional medical advice. Talk to your burn care team or pharmacist about medication dosing, monitoring, and adjustments following burn injury.