Azra Bihorac, MD, MS (born April 2, 1965) is a Bosnian-American professor, nephrologist, and critical care intensivist who is the senior associate dean of research at the University of Florida College of Medicine [1] and the R. Glenn Davis Professor of Medicine, Surgery, Anesthesiology, and Physiology & Functional Genomics. [2] She co-founded the Intelligent Critical Care Center (IC3) research center at the University of Florida in 2021 with Parisa Rashidi.
Azra Bihorac | |
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Born | April 2, 1965 Brčko, Yugoslavia |
Nationality | Bosnian-American |
Education | University of Sarajevo (MD) University of Florida (MS) |
Occupation | Doctor • Professor of medicine • Dean |
Years active | 1990–Present |
Field | Nephrology • Intensive Care • Internal Medicine |
Institutions | University of Florida Health Shands Hospital University of Florida College of Medicine • Intelligent Critical Care Center (IC3) |
Notable Works | Biomarkers of acute kidney injury (AKI) [3] [4] Intensive Intelligent Care Unit (I2CU) [5] [6] • MySurgeryRisk [7] [8] [9] |
Website | https://ic3.center.ufl.edu/ |
Bihorac grew up near Brčko and earned her medical degree from the University of Sarajevo in 1990 [12] (a year before the Yugoslav Wars began) and started working at a hospital in Brčko. [13] On April 29, 1992, weeks after the start of the Bosnian War, Bihorac fled the Bosnian genocide by escaping across the Sava river with her son, her medical degree, and 2,000 deutschmarks "sown in the underlining of [her] trench coat." [14] At 5 a.m. the following morning, the Brčko bridge massacre occurred and killed 100 civilians crossing the bridge. [15]
At Marmara University in Istanbul, Turkey, Bihorac was an internal medicine resident and a nephrology fellow. [12] [16]
In 2000, Bihorac came to the United States as a research fellow of the International Society of Nephrology and began a nephrology training fellowship at the University of Florida College of Medicine. [2] [16] After completing her fellowship at the University of Florida, she remained in the United States. "I got political asylum because I couldn't go back to Turkey, couldn't go back to Bosnia," Bihorac said, "so in order to practice medicine, I had to repeat all of my training." [16]
At the University of Florida, Bihorac began a residency in internal medicine in 2003 and a fellowship in critical care medicine in 2006. [12] She completed a Master of Science for Health Sciences in Clinical Research in 2011. [2] [12]
Since 2010, Bihorac's labs have received continuous funding from the National Institutes of Health (NIH). [17] Her research focuses on using artificial intelligence, machine learning, and deep learning to augment patient diagnostics and monitoring in intensive care medicine. [17] [18] [19] Some of her most well-known work involves identifying biomarkers for acute kidney injury (AKI), treatment of AKI, and AI and machine learning techniques for predicting health outcomes for critically ill patients. As of May 2023, Bihorac's most cited publication is a 2013 study on AKI biomarkers, which has 812 citations. [20]
Under Bihorac's direction, the (IC3) at the University of Florida has gained attention for developments involving the use of AI to
Bihorac has edited or contributed chapters to the following textbooks:
Bihorac's work at the University of Florida has yielded more than 200 peer-reviewed scientific articles—including Scientific Reports , [23] Nature Reviews Nephrology , [24] [25] Critical Care , [3] PLOS ONE , [26] IEEE Journal of Biomedical and Health Informatics , [27] Annals of Surgery , [7] [28] and JAMA Surgery [29] —and over 10,000 citations in other articles. [30]
Bihorac is a Fellow of the American College of Critical Care Medicine (FCCM), [12] a designation given to "practitioners, researchers, administrators, and educators who have made outstanding contributions to the collaborative field of critical care." [31] She is also a Fellow of the American Society of Nephrology (FASN), [12] a designation given to members of the American Society of Nephrology "who have distinguished themselves through excellence in practice or research." [32]
Bihorac is married to surgeon Charles Hobson and lives in Gainesville, Florida, with their children. [36]
Nephrology is a specialty for both adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy. The word "renal" is an adjective meaning "relating to the kidneys", and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" or "kidney replacement therapy", other experts have advocated preserving the use of renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.
Kidney dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Along with kidney transplantation, it is a type of renal replacement therapy.
Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns", a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.
Rhabdomyolysis is a condition in which damaged skeletal muscle breaks down rapidly, often due to high intensity exercise over a short period. Symptoms may include muscle pains, weakness, vomiting, and confusion. There may be tea-colored urine or an irregular heartbeat. Some of the muscle breakdown products, such as the protein myoglobin, are harmful to the kidneys and can cause acute kidney injury.
Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, hyperkalemia, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anaemia.
Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists.
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin coloration (cyanosis). For those who survive, a decreased quality of life is common.
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after transplant.
Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to nephritic syndrome and nephrotic syndrome respectively. Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where dialysis or a kidney transplant is the only treatment option.
Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within seven days, as shown by an increase in serum creatinine or a decrease in urine output, or both.
Peritoneal dialysis (PD) is a type of dialysis that uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure. Peritoneal dialysis has better outcomes than hemodialysis during the first two years. Other benefits include greater flexibility and better tolerability in those with significant heart disease.
Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35. Acidemia and acidosis are not mutually exclusive – pH and hydrogen ion concentrations also depend on the coexistence of other acid-base disorders; therefore, pH levels in people with metabolic acidosis can range from low to high.
A complication in medicine, or medical complication, is an unfavorable result of a disease, health condition, or treatment. Complications may adversely affect the prognosis, or outcome, of a disease. Complications generally involve a worsening in the severity of the disease or the development of new signs, symptoms, or pathological changes that may become widespread throughout the body and affect other organ systems. Thus, complications may lead to the development of new diseases resulting from previously existing diseases. Complications may also arise as a result of various treatments.
Gastrointestinal perforation, also known as gastrointestinal rupture, is a hole in the wall of the gastrointestinal tract. The gastrointestinal tract is composed of hollow digestive organs leading from the mouth to the anus. Symptoms of gastrointestinal perforation commonly include severe abdominal pain, nausea, and vomiting. Complications include a painful inflammation of the inner lining of the abdominal wall and sepsis.
Hemofiltration, also haemofiltration, is a renal replacement therapy which is used in the intensive care setting. It is usually used to treat acute kidney injury (AKI), but may be of benefit in multiple organ dysfunction syndrome or sepsis. During hemofiltration, a patient's blood is passed through a set of tubing via a machine to a semipermeable membrane where waste products and water are removed by convection. Replacement fluid is added and the blood is returned to the patient.
Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney disease. Renal replacement therapy includes dialysis, hemofiltration, and hemodiafiltration, which are various ways of filtration of blood with or without machines. Renal replacement therapy also includes kidney transplantation, which is the ultimate form of replacement in that the old kidney is replaced by a donor kidney.
Acute proliferative glomerulonephritis is a disorder of the small blood vessels of the kidney. It is a common complication of bacterial infections, typically skin infection by Streptococcus bacteria types 12, 4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as postinfectious glomerulonephritis (PIGN) or poststreptococcal glomerulonephritis (PSGN). It can be a risk factor for future albuminuria. In adults, the signs and symptoms of infection may still be present at the time when the kidney problems develop, and the terms infection-related glomerulonephritis or bacterial infection-related glomerulonephritis are also used. Acute glomerulonephritis resulted in 19,000 deaths in 2013, down from 24,000 deaths in 1990 worldwide.
Lipocalin-2 (LCN2), also known as oncogene 24p3 or neutrophil gelatinase-associated lipocalin (NGAL), is a protein that in humans is encoded by the LCN2 gene. NGAL is involved in innate immunity by sequestering iron and preventing its use by bacteria, thus limiting their growth. It is expressed in neutrophils and in low levels in the kidney, prostate, and epithelia of the respiratory and alimentary tracts. NGAL is used as a biomarker of kidney injury.
Onconephrology is a specialty in nephrology that deals with the study of kidney diseases in cancer patients. A nephrologist who takes care of patients with cancer and kidney disease is called an onconephrologist. This branch of nephrology encompasses nephrotoxicity associated with existing and novel chemotherapeutics, kidney disease as it pertains to stem cell transplant, paraneoplastic kidney disorders, paraproteinemias, electrolyte disorders associated with cancer, and more as discussed below.
Renal infarction is a medical condition caused by an abrupt disruption of the renal blood flow in either one of the segmental branches or the major ipsilateral renal artery. Patients who have experienced an acute renal infarction usually report sudden onset flank pain, which is often accompanied by fever, nausea, and vomiting.