Acute Kidney Injury: A Startup’s Solution for This Silent Killer
A disturbing fact stuck with Aaron Chang throughout his rotation in cardiac surgery. On average, 15 percent of cardiac surgeries result in acute kidney injury (AKI), a condition which greatly impacts life expectancy. Even more disturbing, patients who sustain a stage 1 kidney injury, the least severe of the three stages before kidney failure, become 2.2 times more likely to die within five years.
“Acute kidney injury is the silent killer nobody talks about,” says Chang, a 2015 master’s graduate of the Johns Hopkins School of Biomedical Engineering.
In addition to their serious health detriments, acute kidney injuries drive up health care costs, as patients who suffer stage 1, 2 or 3 kidney injuries typically spend an extra 3.5 days in the ICU.
The rate of acute kidney injuries is so high, Chang says, because doctors can’t adequately identify the optimal blood pressure for individuals during surgery, a level that varies based on patient size, fitness, medical history and many other variables. The current gold standard of care in detecting AKI is observing a rise in serum creatinine, a blood biomarker, but this doesn’t happen until 24 to 48 hours after the injury has occurred.
“In cardiac surgery, doctors rely on generalized guidelines to set people’s blood pressure, but every person is different,” Chang says. “If these guidelines don’t fit the individual, the patient’s kidneys essentially hold their breath for the entire one- to three-hour procedure. There’s currently no way to see in real time how the kidneys are doing during surgery.”
Chang founded Renalert in 2015 to develop a real-time urine analysis device for the prevention of acute kidney injury. Currently operating out of Johns Hopkins Technology Ventures’ (JHTV) FastForward 1812 innovation hub, Renalert’s device sits beneath operating tables and monitors patient urine in real time, providing more precise measurements than the visual analyses typically used, while also incorporating additional correlations to other real-time vital signs.
A recent 30-patient pilot study Chang organized at Johns Hopkins Hospital showed observational significance between low urine flow during surgery and higher rates of acute kidney injuries.
“If doctors knew of potential injury earlier, there’s plenty of ways they could ensure the patient’s kidneys are perfused,” Chang says. “If at a certain blood pressure no urine is coming out, the doctor would know to increase it.”
With more studies currently underway at Johns Hopkins Hospital and Northwestern Memorial Hospital, Chang hopes to optimize the device’s algorithm and validate these results.
Chang has also begun discussions with Johns Hopkins’ Technology Innovation Center to allow Renalert’s device to feed information into EPIC, Johns Hopkins’ integrated medical record system, to uncover other potential areas where Renalert could improve outcomes. After initial analyses, Chang has identified orthopaedics, liver transplants and minimally invasive surgeries as potential areas to examine.
Renalert’s efforts have received support from the Wallace H. Coulter Foundation, TEDCO’s Maryland Innovation Initiative and the Johns Hopkins School of Medicine Dean’s Faculty Innovation Award.
Though his vision for Renalert is clear, navigating the startup landscape is challenging. That’s why he has sought the support of JHTV, which provides Baltimore-area startups with the resources they need to reach their potential.
In addition to FastForward 1812’s proximity to the hospital, the support Renalert received in licensing technology, setting up a corporation correctly and building relationships with potential investors has made Baltimore an attractive place for the startup.
“FastForward provides pro bono legal services, connections with investors and affordable space in a beautiful building on the Johns Hopkins medical campus,” Chang says.