Hi Udit, great question, unclear answers. Poor UOP is a surrogate (but not perfect) measurement for renal perfusion, which, along with cardiac ischemia, is our big concern with underresuscitation of the massive burn patient. You are correct in the need for other parameters to assess for volume status, which is very tricky with the big burn (IVC assessment, TTE, passive leg raise, CVP, cardiac outputs, are all challenging when the patient is fully wrapped in heavy dressings and 15L positive). I would consider adding albumin at the 8-12 hr mark, low dose vasopressors if fluid status adequate but MAP low. However, once AKI leads to ATN, or you have established CKD/ESRD, then you are likely on the road to continuous dialysis modalities. Kevin Chung has done some interesting work in this field (with CVVH and burns, and good outcomes), but like all dialysis studies in critical care, the perfect answer has not yet been found. Good luck! — Dennis