Infection that kills 200 times more patients than MRSA superbug: One person in five admitted for surgery or to treat infection develops acute kidney damage

  • You are more likely to get acute kidney injury (AKI) than hospital superbug
  • Maura Murray, 72, form Surrey developed AKI in April 2012
  • She was recovering in hospital after surgery for a broken thigh bone
  • Began shaking uncontrollably when she got home, something called a 'rigor' 
  • Doctor insisted that the symptom was caused by the painkillers
  • Her kidney function is now just 20 per cent, and she tires easily

By Jane Feinmann

Maura Murray, 72, now lives with 20 per cent kidney function


When you go to hospital for surgery, your main concern is that the procedure is a success and fixes the problem.

A secondary concern might be worries about catching a hospital superbug - but that fear may be misplaced, because you are actually much more likely to develop acute kidney injury (AKI).

Few people have heard of AKI, let alone realise they could be at risk. But astonishingly, one patient in five admitted to hospital for surgery or to treat an infection - that's half a million people in the UK every year - develops AKI.

The condition causes the kidneys to shut down within days and, left untreated, can lead to severe dehydration and even death. Every year at least 12,000 people die of acute kidney injury - that's 200 times more deaths than are caused by MRSA (methicillin-resistant staphylococcus aureus).

Furthermore, up to 1,000 more people per year need a lifetime of dialysis or a kidney transplant as a result of what should be an entirely treatable condition.

Acute kidney injury is also hugely expensive to the NHS - costing more to treat each year than breast cancer. Yet the sums needed to diagnose and treat it are negligible.

Diagnosis requires a simple blood test along with regular measurement of urine output. Treatment is with standard antibiotics and intravenous fluids to rehydrate the kidneys.

What worries experts is that too often medics dismiss AKI symptoms as insignificant.

Maura Murray's experience is typical. In April 2012, the retired maths teacher from Surrey, now 72, was recovering in hospital after surgery for a broken thigh bone.

The night before she was discharged, she had to go to the loo several times - and told the nurse she was worried she might have picked up a urinary tract infection.

'The nurse told me that going to the loo frequently was normal after having a catheter removed,' says the mother of three grown-up children.


It's true that having a urinary catheter can make the urethra extra-sensitive for a day or so, causing people to go to the loo more frequently.

But one person in ten who has a urinary catheter removed develops a urinary tract infection - and this can easily move to the kidneys if untreated. Indeed, a urinary tract infection is a main reason for acute kidney injury following post-surgery.

'It should have rung alarm bells with the nurse, but at the time I was delighted to be reassured,' says Maura. 'The last thing I wanted was to stay in hospital.'

Within hours of getting home she was shaking uncontrollably, a symptom known as a 'rigor'


So she was discharged as planned. But within hours of getting home she was shaking uncontrollably, a symptom known as a 'rigor' that is associated with serious infections.

This should have been a red flag for AKI in someone who is over 65 and has had recent surgery, says Professor Donal O'Donoghue, a kidney specialist at Salford Royal NHS Foundation Trust.

Yet when Maura's husband Gerard, 74, called their GP surgery, the doctor insisted that the symptom was caused by the painkillers she'd been given by the hospital - and told her to switch to paracetamol.

Two days later, Maura was still suffering from uncontrollable shaking and persistent vomiting.
Her husband rang the GP, who prescribed antibiotic tablets. 'Even if I could have kept them down, the antibiotics on their own were no help at all - as I subsequently discovered,' says Maura. 'I also needed intravenous fluid to hydrate the kidneys and protect them from damage.'

Over the following week, three more doctors made reassuring noises as Maura became steadily more dehydrated.

Eventually, her face swelled up - a sign of severe dehydration - and her husband called 999.
Within an hour, an A&E doctor had diagnosed acute kidney injury and Maura was put on a drip.
'I later found out that I only had 10 per cent of kidney function left,' says Maura. Yet astonishingly, once admitted to a hospital ward, she continued to suffer because of staff ignorance of the condition.
'No one measured my blood or hydration levels and the drip was not replaced. I was just told to drink, even though I still couldn't hold anything down.


The number of litres of urine filtered by the kidneys every 24 hours

'Nor did I see a kidney specialist - even though one was on duty in the hospital that weekend.

'I just don't think anyone had a clue why I was in hospital, and no one really cared.'

Maura believes it was only by a fluke that she survived. After three days, staff became convinced - wrongly - that she had the superbug clostridium difficile. By then she was 'barely alive, unable to keep anything down and with severe diarrhoea'. But a family friend put them in touch with a kidney specialist attached to the hospital.

'If this doctor hadn't walked into the room where I was being left to deteriorate, and insisted on supervising my care, I'm certain I would have died,' Maura says.

The specialist saw her every day for a week, insisting on daily blood tests, then fortnightly as an outpatient for the next three months. 'I was anaemic due to AKI and needed blood transfusions and checks to ensure my blood pressure was normal,' she says.

Two years on, her kidney function is now 20 per cent. She tires easily but fortunately does not need dialysis or a kidney transplant.

'All of this was so unnecessary,' says Professor O'Donoghue, who co-authored an official report that highlighted the problem. 'At the point where someone has developed a bacterial infection, it can be treated successfully with a simple antibiotic.'

Commenting on the nurse's response to Maura when she was first discharged from hospital, he says: 'Here we have a typical example of someone not bothering to listen to the patient.

'It's an example of the deep-rooted professional complacency about the symptoms of dehydration in healthcare today.'

She was left without intravenous hydration and nearly died

She was left without intravenous hydration and nearly died

The problem, according to Dr Ed Kingdon, a kidney specialist at Brighton & Sussex University Hospitals NHS Trust, is that doctors have traditionally focused on treating AKI when the kidneys have failed - rather than intervening to prevent the infection spreading in the first place.

'Medical students learn that AKI is a kidney disorder, and once they qualify it doesn't occur to them that every patient can develop AKI.

'Nor do they take into account that older people and those already suffering from diabetes, heart failure, liver disease or a kidney disorder are especially at risk.'

Once AKI is suspected, diagnosing it is quite simple. A blood test to measure levels of creatinine (a waste product filtered out by the kidneys) shows if the kidneys are performing. This is already a routine test carried out when people are admitted to hospital.

Dr Mark Thomas, a kidney specialist at the Heart of England NHS Foundation Trust, explains that healthcare professionals need to use these results and compare them with further tests, to monitor the patient for signs of AKI. 'But too often this isn't happening,' he says.

The hope is that new guidelines, published last year by the National Institute for Health and Care Excellence (NICE), will change this. They state that anyone over the age of 65, as well as those admitted to hospital with a  long-term heart or liver disorder, or who has an infection, should have their creatinine levels monitored regularly.

Maura is campaigning to make everyone more kidney-aware. 'Doctors, nurses and patients should know that uncontrolled shaking could be a symptom of AKI - and as such is an emergency,' she says.
'It's been truly shocking to discover that it's quite common for doctors to ignore a disorder that's easily as dangerous as a heart attack or stroke.'

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