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
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Urinary renin is proposed to be a novel prognostic biomarker of AKI in adult patients.
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There are some differences between children and adults in physiological and pathophysiological characteristics.
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This study demonstrated that urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children.
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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.
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Acknowledgements
This work was supported by grants from the National Natural Science Foundation of China (81971432 and 81370773); Jiangsu Province Science and Technology Support Program (BE2020660); Natural science foundation of JiangSu province (BK20171217); and Key talent of women’s and children’s health of JiangSu province (FRC201738). The funders had no role in study design, data collection, preparation of the manuscript, and decision to publish.
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Y.K. participated in data analysis and drafted the manuscript. H.H. performed the experiments. X.D., Z.Z., Z.B., and J.C. participated in collecting the data and samples. F.F., J.P., and X.L. participated in data analysis and interpretation. J.W. participated in the design of the study and coordination. Y.L. had primary responsibility for study design, performing the experiments, data analysis, interpretation of data, and writing the manuscript. All authors read and approved the final manuscript.
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Patient consent statement
The study was approved by the Institutional Review Board of the Children’s Hospital of Soochow University, and parental written informed consent was obtained for all participants.
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Kuai, Y., Huang, H., Dai, X. et al. In PICU acute kidney injury stage 3 or mortality is associated with early excretion of urinary renin. Pediatr Res 91, 1149–1155 (2022). https://doi.org/10.1038/s41390-021-01592-6
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DOI: https://doi.org/10.1038/s41390-021-01592-6
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