Division of Pediatric Nephrology Welcomes New Faculty Member Cassandra Formeck, MD

In July, the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh welcomed its newest faculty member, Cassandra Formeck, MD.

Dr. Formeck completed her undergraduate studies in neuroscience at the University of Pittsburgh, followed by her medical degree from The Ohio State University College of Medicine and residency at Nationwide Children’s Hospital. 

In 2016, Dr. Formeck began a fellowship in pediatric nephrology at UPMC Children’s, and subsequently became a postdoctoral scholar on the Division’s NIH T32 training grant immediately prior to accepting her faculty position as an assistant professor.

Dr. Formeck gained an early interest in urinary tract pathology and physiology as an undergraduate, which led her to perform research on the neural regulation of urogenital tract function during postnatal development and following neural injury under the mentorship of William de Groat, PhD, at the University of Pittsburgh Department of Pharmacology and Chemical Biology. During medical school and residency, Dr. Formeck had the opportunity to investigate antimicrobial peptides and urinary tract immunity. In 2018, Dr. Formeck presented two abstracts at the American Society of Nephrology Kidney Week. Her research conducted at UPMC Children’s as a fellow involved studies of hyponatremia associated with the development of sepsis and acute kidney injury epidemiology, risk factors, and prevention.

“Early in my medical training, I found myself drawn toward patients with complex renal issues. These patients tested my medical knowledge and engaged my critical thinking. Through residency and my exposure to the diversity of pediatric medicine, I found nephrology both compelling and fulfilling,” says Dr. Formeck.

Dr. Formeck Awarded UPMC Children’s Scholar’s Program Award

Upon completing her fellowship, Dr. Formeck applied for and was awarded a UPMC Children’s Scholar’s Program grant. This competitive, internal two-year funding award supports early and junior faculty members with additional training on the path to becoming independent physician-scientists. 

Dr. Formeck’s research has been focused on acute kidney injury as a risk factor for subsequent infections in the critical care setting. With the funding support from the UPMC Children’s Scholar’s Program, Dr. Formeck will continue her AKI research and attempt to find causal pathways between acute kidney injury and subsequent infections, such as sepsis. Dr. Formeck will be working with the Center for Causal Discovery at the University of Pittsburgh, whose main interest is in using causal discovery methods to derive valid, novel, and significant causal relationships from large biomedical data sets to spur new insights and therapies.

New Paper Links AKI with Sepsis in Critically Ill Patients

In August, Dr. Formeck published a new paper1 in the journal Pediatric Critical Care Medicine on the association between acute kidney injury and the subsequent development of sepsis in critically ill children. Joining Dr. Formeck on the study was Division of Pediatric Nephrology colleague Dana Y. Fuhrman, DO, and former Division Faculty Emily Joyce, MD The senior author on the paper is internationally-respected acute kidney injury expert John A. Kellum, MD, Endowed Chair in Critical Care Research, and Vice-Chair for Research in the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine.

Dr. Formeck's study, a single-center retrospective analysis, examined data from more than 5,000 cases of children treated at UPMC Children's pediatric and cardiac critical care units, 255 of which were identified as having a stage 2 or 3 acute kidney injury (AKI).

"There has been a lot of discussion about the immunological components of having acute kidney injury and whether or not AKI predisposes one to severe infections – including sepsis. Our study was designed to specifically look at what associations or risks exist for AKI patients to develop sepsis. Both AKI and sepsis have high rates of morbidity and mortality, with AKI having no directed therapeutic treatment options at this time. Both are a challenge to treat, but if we know that AKI patients are susceptible to sepsis or other infections, we may be able to identify modifiable mediators that allows us to reduce the risk for subsequent infection and thereby reduce mortality in these patients," says Dr. Formeck

Of the 255 children identified with a stage 2 or 3 AKI, 18% went on to develop suspected sepsis, compared to 5.4% of critically ill children stage 1 or no AKI. When adjusting for other factors, children with stage 2/3 AKI had more than a two-fold increase in the risk of subsequent sepsis. Those with a stage 2 AKI were shown to exhibit a 1.79-fold increase in the odds of developing sepsis, while those with a stage 3 AKI showed a more than three-fold increase in odds – 3.24 to be exact.

"Not only have we shown that AKI increases the risk for subsequent infection in a heterogenous cohort of critically ill children, but our study also supports the concept of AKI as a clinically relevant immunocompromised state. More work will need to be done to further our findings," says Dr. Formeck.

Reference

1. Formeck CL, Joyce EL, Fuhrman, DY, Kellum JA. Association of Acute Kidney Injury With Sepsis in Critically Ill Children. Pediatr Crit Care Med. 2020 Aug 27. Epub ahead of print.