Yuxian Kuai1, Hui Huang1, Xiaomei Dai1, Zhongyue Zhang1, Zhenjiang Bai2, Jiao Chen2, Fang Fang3, Jian Pan3, Xiaozhong Li1, Jian Wang3, Yanhong Li4,5. 1. Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China. 2. Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China. 3. Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China. 4. Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China. lyh072006@hotmail.com. 5. Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China. lyh072006@hotmail.com.
Abstract
BACKGROUND: Urinary renin is proposed to be a novel prognostic biomarker of acute kidney injury (AKI) in adults. The intention of our study was to evaluate the early predictive value of urinary renin for AKI and pediatric intensive care unit (PICU) mortality in critically ill children. METHODS: The first available urine sample during the first 24 h after admission was collected upon PICU admission for the measurement of renin using ELISA. Urinary renin concentrations were corrected for urinary creatinine (urinary renin-to-creatinine ratio, uRenCR). AKI was defined based on KDIGO criteria. RESULTS: Of the 207 children, 22 developed AKI, including 6 with stage 1, 6 with stage 2, and 10 with stage 3, and 14 died during PICU stay. There was a significant difference in uRenCR between non-AKI children and those with AKI stage 3 (P = 0.001), but not with AKI stage 1 or 2. The uRenCR remained associated with AKI stage 3 and PICU mortality after adjustment for potential confounders. The area under the receiver operating characteristic curve of uRenCR for discrimination of AKI stage 3 was 0.805, and PICU mortality was 0.801. CONCLUSIONS: Urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. IMPACT: Urinary renin is proposed to be a novel prognostic biomarker of AKI in adult patients. There are some differences between children and adults in physiological and pathophysiological characteristics. This study demonstrated that urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. Accurate identification of patients with severe renal injury or at high risk for mortality early in the disease course could augment the efficacy of available interventions and improve patient outcomes.
BACKGROUND: Urinary renin is proposed to be a novel prognostic biomarker of acute kidney injury (AKI) in adults. The intention of our study was to evaluate the early predictive value of urinary renin for AKI and pediatric intensive care unit (PICU) mortality in critically ill children. METHODS: The first available urine sample during the first 24 h after admission was collected upon PICU admission for the measurement of renin using ELISA. Urinary renin concentrations were corrected for urinary creatinine (urinary renin-to-creatinine ratio, uRenCR). AKI was defined based on KDIGO criteria. RESULTS: Of the 207 children, 22 developed AKI, including 6 with stage 1, 6 with stage 2, and 10 with stage 3, and 14 died during PICU stay. There was a significant difference in uRenCR between non-AKI children and those with AKI stage 3 (P = 0.001), but not with AKI stage 1 or 2. The uRenCR remained associated with AKI stage 3 and PICU mortality after adjustment for potential confounders. The area under the receiver operating characteristic curve of uRenCR for discrimination of AKI stage 3 was 0.805, and PICU mortality was 0.801. CONCLUSIONS: Urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. IMPACT: Urinary renin is proposed to be a novel prognostic biomarker of AKI in adult patients. There are some differences between children and adults in physiological and pathophysiological characteristics. This study demonstrated that urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. Accurate identification of patients with severe renal injury or at high risk for mortality early in the disease course could augment the efficacy of available interventions and improve patient outcomes.
Authors: Chia-Hua Wu; Shayan Mohammadmoradi; Jeff Z Chen; Hisashi Sawada; Alan Daugherty; Hong S Lu Journal: Arterioscler Thromb Vasc Biol Date: 2018-07 Impact factor: 8.311