Critically ill children with septic shock: time to rediscover renin?

Abstract

Acute kidney injury (AKI) and sepsis are both associated with morbidity and mortality in critically ill patients. In detail, critically ill children with severe AKI (KDIGO stage 2 or 3) had a higher 28-day mortality than children without severe AKI (11% vs. 2.5%) and sepsis-associated AKI (SA-AKI) was independently associated with increased odds of mortality in a large cohort of children with septic shock [1,2]. Furthermore, the incidence of SA-AKI has increased over the past two decades, affecting mortality, hospitalization, and costs in this population [3]. Thus, early recognition of children at higher risk of developing SA-AKI could potentially be effective in improving septic patients' management and outcomes.In a recent paper in Pediatric Nephrology, Stanski and colleagues presented the results of a secondary analysis of a large, prospective, observational study, looking at the impact of elevated serum renin + prorenin concentration as a predictor of persistent AKI and mortality in children with septic shock [4]. In a cohort of 233 critically ill children with septic shock, an elevated renin + prorenin concentration at day 1 was predictive of severe persistent AKI in the first week of pediatric intensive care unit (ICU) stay. Similarly, persistence of renin + prorenin elevation at day 3 (as quantified by day 3:day 1 renin + prorenin ratio above an optimal cutoff) was predictive of 28-day mortality [4]. Therefore, the authors suggested that renin may be a valuable prognostic and predictive biomarker in pediatric critically ill patients with septic shock, which, if confirmed by further studies, may potentially guide therapy and improve outcomes in this population.