The midwife striving to protect pregnant mums
A London midwife is determined to prevent pregnant mums and their babies being harmed by acute kidney injury (AKI), through her pioneering research project.
Katherine Clark wants to develop a routine test for this highly dangerous condition where the mother’s kidneys suddenly stop working, putting both mum and baby at risk.
Simple finger prick or urine test
Thanks to funding by Kidney Research UK, Katherine hopes her work will lead to a routine simple finger prick or urine test so women know if they are at risk of developing the condition.
A qualified midwife for 10 years, Katherine, of King’s College Hospital, London, said: “Sadly, I have now looked after two women whose babies have died and the mum was in intensive care with an acute kidney injury.
“I could see how we could make things better, so I had to try. I hope my research work makes a huge difference for women.
“I want us to be able to step in sooner, even before women develop AKI, to prevent, then treat the condition and prevent it worsening.”
High blood pressure and pregnancy can lead to acute kidney injury (AKI) - left undetected, AKI can cause irreversible damage. Doctors and midwives diagnose it using a blood test to detect raised levels of toxic chemicals in the blood called creatinine. But creatinine levels usually fall during pregnancy, can vary according to ethnicity, and nobody knows what the normal range is in pregnancy.
“We don’t check creatinine routinely. This all means it is harder to judge when there could be a problem. Rather than waiting for the creatinine to go sky high I hope we can see subtle changes and provide interventions.”
Katherine’s research will establish the normal creatinine ranges in pregnancy and see if the levels are different for women from different ethnic backgrounds. She hopes to then establish which women are most at risk.
As part of Katherine’s work, she aims to see if midwives can use a quick finger-prick test or urine test to predict those at risk and diagnose AKI more quickly.
More than 1,600 women will be asked to take part in Katherine’s research at three London hospitals (Kings, Barts and The Royal London and Guys and St Thomas’) as well as hospitals in Nottingham and Bristol.
Although the Covid-19 pandemic delayed recruitment of women to the research project, this should be under way for 2021.
The four-year study is split into four components and is in its first year.
Study A will work out the normal range of creatinine levels in pregnancy.
Study B will use big international data sets to determine how to detect AKI in pregnant women. Medics know creatinine in pregnancy can safely rise by as much as 1.5 times, yet out of pregnancy that rise can trigger concerns.
“We need a different way of knowing who is sick and who isn’t sick,” Katherine said, who is using data sets from Sweden, the UK and Canada. She will trawl the data of around one million women to find her answers.
Study C will use a finger prick and a urine test to determine which is best to help predict acute kidney injury.
Study D is a project aimed at finding interventions and treatment options.
Passionate about research
“My hypothesis is that the test can be done once a woman is admitted to hospital in labour or because of an issue and she is admitted early,” explains Katherine.
“We would screen the woman on a traffic light system. Green is OK, at amber we would do simple things like reduce any drugs that could put extra pressure on the kidneys and be careful about the amount of fluids, then constantly monitor. Red is where the woman is likely to have an AKI already, so needs specialist input. Without the test this could be missed, and the woman could be much sicker before we notice.”
Away from her day job and her research work, Katherine recently ran the virtual London Marathon 2020 raising more than £2,800 for Kidney Research UK. She aims to do the real thing around the streets of the capital in 2022.
“Katherine’s commitment is commendable,” said Dr Aisling McMahon, research and policy director at Kidney Research UK. “Her project has the potential to save lives and is a great example of how healthcare professionals who are not already kidney doctors or nurses can impact kidney health through research. We’re looking forward to seeing how it unfolds.”
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