04:31am Monday 20 January 2020

‘Kidney Attack’ As Serious as Heart Attack, Warns UPMC Critical Care Expert

Acute kidney injury (AKI) is not well understood by doctors, and is even more unfamiliar to the public, wrote John A. Kellum, M.D., professor and vice chair for research, Department of Critical Care Medicine, Pitt School of Medicine; Rinaldo Bellomo, M.D., of Austin Hospital and Melbourne University, Australia; and Claudio Ronco, M.D., Ospedale San Bortolo, Vicenza, ltaly.

“Research shows that as many as 60 percent of patients in the intensive care unit will develop kidney problems, which can lead to long-term, life-threatening complications,” Dr. Kellum said. “Doctors, patients and families should perhaps view the dangers of and the need to avoid a ‘kidney attack’ with the same sense of urgency that heart attack provokes.”

Until recently, there were no recommendations about when to start treatments, such as a medication change, correcting fluid overload, or dialysis, in response to abnormal kidney function, he said. But in March, an international panel of experts co-chaired by Dr. Kellum established clinical practice guidelines to end the confusion.

At UPMC, an effort will launch this month in which an alert will appear in the electronic medical record when certain lab tests of kidney function are abnormal. It will cue the medical staff to seek advice about appropriate therapeutic strategies from nephrologists or, in the case of severe illness, critical care specialists.

“That’s a simple way of making sure that the patient gets assessed early by clinicians who have the most experience in managing AKI,” Dr. Kellum said. “UPMC already includes a sign of kidney attack – very low urine   output – as a trigger for its rapid-response team. The idea is to address kidney attacks just as we do with cardiac arrest and other scenarios in which a patient becomes dangerously ill very quickly.”

And, as detection and public awareness of AKI improves, there could be more support for research into the problem, said the authors, who noted also that estimates indicate that in 2012, 3 million people worldwide could die of AKI, which currently has no definitive treatment.

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