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Serum renin and prorenin concentrations predict severe persistent acute kidney injury and mortality in pediatric

Natalja L Stanski1,2, Naomi Pode Shakked3,4, Bin Zhang5

  • 1Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. natalja.stanski@cchmc.org.

Pediatric Nephrology (Berlin, Germany)
|March 20, 2023
PubMed

Insights

Elevated serum renin concentrations in children with septic shock predict severe acute kidney injury and mortality. Monitoring these levels and their trends can help identify high-risk pediatric patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Renal Physiology
  • Sepsis Pathophysiology

Background:

  • Renin-angiotensin-aldosterone system (RAAS) dysregulation is linked to poor outcomes in adult critical illness.
  • Data on serum renin concentrations and their prognostic value in pediatric septic shock are limited.
  • This study investigates serum renin + prorenin as a potential biomarker in critically ill children.

Purpose of the Study:

  • To assess serum renin + prorenin concentrations in children with septic shock.
  • To determine the predictive ability of these concentrations for severe persistent acute kidney injury (AKI) and mortality.
  • To evaluate the prognostic value of renin + prorenin trends over the first 72 hours.

Main Methods:

  • Secondary analysis of a multicenter observational study involving children (1 week to 18 years) with septic shock.
  • Measurement of serum renin + prorenin concentrations on day 1 and day 3.
  • Primary outcomes: severe persistent AKI (≥ KDIGO stage 2 for ≥ 48 hours) and 28-day mortality.

Main Results:

  • Day 1 serum renin + prorenin predicted severe persistent AKI (AUROC 0.75) and mortality (AUROC 0.79).
  • Elevated day 1 concentrations were independently associated with severe persistent AKI (aOR 6.8) and mortality (aOR 6.9).
  • The day 3/day 1 renin + prorenin ratio also predicted mortality (AUROC 0.73; aOR 7.6).

Conclusions:

  • Critically ill children with septic shock exhibit significantly elevated serum renin + prorenin levels.
  • These concentrations and their trends are valuable predictors of severe persistent AKI and mortality.
  • Serum renin + prorenin serves as a potential prognostic biomarker in pediatric septic shock.
Abstract

Keywords:
Acute kidney injuryMortalityPediatricsReninSepsis

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