{"doi":"10.1007/s00467-022-05843-4","title":"4th International Symposium on Acute Kidney Injury in Children","abstract":"Background: Elevated serum renin concentrations are associated with poor outcomes in critically ill adults.Data suggest that these associations may be stronger in children with septic shock, in whom endothelial damage is hypothesized to lead to angiotensin-converting enzyme (ACE) dysfunction and derangements in the renin-angiotensin-aldosterone system (RAAS) (Figure 1).However, no studies support this hypothesis.We examined the relationship between renin levels, ACE levels, ACE activity and outcomes in children with septic shock.Methods: A pilot study using subjects from a multicenter observational study of pediatric septic shock.72/379 children were selected based on the availability of residual Day 1 (D1) serum.On D1, serum renin concentrations were measured by Luminex® assay (normal <59 pg/ml), serum ACE levels via ELISA assay (median in healthy children: 200 ng/ml), and ACE activity by high-sensitivity enzymatic assay (normal adult range: 16-85 U/L; expected 20-50% higher in children).The associations between each RAAS component and outcomes, and their relationship to each other, were assessed.Results: Median D1 renin concentration was 3940 pg/ ml (IQR 1749-11671); D1 renin >median was associated with higher D1 vasoactive-inotrope score (VIS), increased odds for severe persistent AKI and 28-day mortality, and fewer PICU-free and vasoactive-free days (Table 1).Median D1 ACE level was 104 ng/ml (IQR 78-149), and patients with D1 renin levels >median had higher ACE levels (Table 1).D1 ACE levels >median were associated with increased odds of severe persistent AKI and renal replacement therapy (RRT) requirement (Table 1).68/72 children had ACE activity <12.050U/L, with 50/72 (69%) measuring undetectable (<2.41 U/L).Compared to those with detectable ACE activity, ACE activity <2.41 U/L was associated with higher D1 renin concentrations (median 4533 [IQR 2782-21834] vs. 2227 [IQR 1053,6284], p=0.017);ACE levels did not differ between these 2 groups.","journal":"Pediatric Nephrology","year":2023,"id":384585,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9584,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T01:17:37.110513Z","pmid":"36715771","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}