{"id":4630,"date":"2018-08-14T14:55:00","date_gmt":"2018-08-14T18:55:00","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/erica-bjornstad-md-mph-studies-epidemiology-of-acute-kidney-injury-in-malawi-1\/"},"modified":"2023-06-06T17:23:49","modified_gmt":"2023-06-06T21:23:49","slug":"erica-bjornstad-md-mph-studies-epidemiology-of-acute-kidney-injury-in-malawi-1","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/medicine\/news\/erica-bjornstad-md-mph-studies-epidemiology-of-acute-kidney-injury-in-malawi-1\/","title":{"rendered":"Erica Bjornstad Studies Epidemiology of Acute Kidney Injury in Malawi"},"content":{"rendered":"
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\"image2\"
Erica Bjornstad, MD, MPH<\/figcaption><\/figure>
<\/figcaption><\/figure>\n<\/div>\n
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A June report from the American Society of Nephrology identifies kidney disease as a hidden \u2018epidemic\u2019 that affects more than 850 million people worldwide–double the number of diabetics (422 million) and more than 20 times the number of people with cancer (42 million) or HIV\/Aids (36.7 million). Many patients with kidney disease are not aware of their risk, most often because there are no early symptoms. UNC\u2019s division of nephrology is focused on a research portfolio of clinical, translational and basic kidney research, and this includes early diagnosis.<\/p>\n

Last December, Erica Bjornstad, MD, MPH, a third-year pediatric nephrology fellow, received a funding award from the International Society of Nephrology to study the epidemiology of acute kidney injury (AKI) in a Malawian trauma cohort. The UNC Kidney Center<\/a> matched this funding, and now Bjornstad\u2019s project is well underway at Kamuzu Central Hospital<\/a>, in conjunction with UNC Project Malawi<\/a> and the UNC Department of Surgery\u2019s Malawi Surgical Initiative<\/a>.<\/p>\n

AKI refers to a sudden decrease in kidney function and it requires immediate treatment. AKI causes a build-up of urea and other nitrogenous waste, and this makes it difficult for the kidneys to keep the right balance of fluid and electrolytes. Few studies have evaluated AKI in trauma patients in Africa, despite trauma being the number one cause of death in young people across the continent.<\/p>\n

\u201cWe know that for people in Malawi, there are a lot of injuries from road traffic accidents, burns and falls, particularly children,\u201d said Bjornstad. \u201cWhen muscles break down from such injuries, toxins are released that gum up the kidney, and this can lead to renal failure. What we don\u2019t know is how many of these traumas are leading to AKI or renal failure due to limited diagnostic tests.\u201d<\/p>\n

Unlike chronic kidney failure that results from kidney damage that gets worse slowly, AKI can be reversed if it is found and treated quickly. But in places with limited resources, with different comorbidities and different access to medications and health care, a fast, reliable diagnostic test is virtually nonexistent. In addition, with each episode that occurs, a patient\u2019s chances of experiencing chronic renal failure can increase. Bjornstad adds that in Malawi, there is an under recognition of what to do after an injury to prevent AKI. She wants to address this knowledge gap with education.<\/p>\n

\u201cAKI occurs in approximately 30% of South African trauma patients, but we don\u2019t know how many in Malawi. We do know that it\u2019s one of the poorest countries in Africa with a very high trauma rate. We also know that repeated episodes of AKI lead to an increased risk of chronic kidney disease that is difficult to effectively manage, with usually no hope of getting a transplant.\u201d<\/p>\n

Seeking a Rapid Diagnosis.<\/span><\/b><\/p>\n

\"Dr.
Dr. Erica Bjornstad with a study nurse obtaining a saliva sample from a patient.<\/figcaption><\/figure>\n

Working with Dr. Anthony Charles<\/a>, leader of the UNC Malawi Surgery Initiative and associate professor of surgery acute care, Bjornstad is investigating the viability of two novel diagnostic dipstick tests that she hopes will enable a quicker diagnosis in limited resource settings. One test measures the diagnostic performance of a dipstick in urine for a novel biomarker, NGAL.<\/p>\n<\/div>\n

\n

\u201cIf we can prevent kidney disease upstream, then we can potentially prevent the downstream effects, as well as the need for dialysis and transplants. At this time, only 80 patients throughout Malawi can have access to dialysis treatment, based on hospital capacity. There is no ability for transplants in the country or even in neighboring countries.\u201d<\/p>\n

Bjornstad will be back in Malawi this fall to review data from 480 participants–comprised of adults and children–and will focus on a treatment algorithm that can improve care.<\/p>\n

\u201cIf our tests are promising, we\u2019ll be able to aid not only the people in Africa, but also people in other places with limited resources, and disaster events, such as hurricanes and earthquakes, that affect people all around the world, including the US and North Carolina.\u201d<\/p>\n

Bjornstad adds that AKI can be treated with IV fluids and careful management that avoids medications that make it worse, preventing patients from having acute kidney failure altogether. But the higher the injury, the harder it is to manage. The more episodes a patient has, the higher the risk for renal failure.<\/p>\n

\u201cWe know that after the recent hurricane in Puerto Rico, there was a long delay before routine laboratory facilities were back online. Having a method for diagnosing AKI in such settings will be extremely valuable.\u201d<\/p>\n

 <\/p>\n

\n<\/div>\n","protected":false},"excerpt":{"rendered":"

<\/p>\n

New diagnostic tests could offer a quicker diagnosis for impaired kidney function, for not only people in Africa, but in other places with limited resources, as well as disaster events like hurricanes and earthquakes that affect people around the world.<\/p>\n","protected":false},"author":69419,"featured_media":4631,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[101,2],"tags":[22],"class_list":["post-4630","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nephrology","category-news","tag-22","odd"],"acf":[],"yoast_head":"\nErica Bjornstad Studies Epidemiology of Acute Kidney Injury in Malawi | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" 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