Observational studyCritical care (London, England)2023
Increasing angiotensin-converting enzyme concentrations and absent angiotensin-converting enzyme activity are associated with adverse kidney outcomes in pediatric septic shock.
Observational study in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
What it found
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The trial behind it
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Who cites it
16 citing papers in PubMed, 20 citations in OpenAlex.
- The AGT M235T variant and renin-angiotensin-aldosterone system parameters in a predominantly hypertensive elderly black South African cohort: a hypothesis-generating descriptive case series.Molecular biology reports · 2026Article
- Pediatric sepsis-associated acute kidney injury: leveraging pathophysiology for risk stratification and identification of treatable traits.Pediatric nephrology (Berlin, Germany) · 2026Review
- External Validation, Molecular Signatures, and Therapeutic Relevance of Pediatric Sepsis-Associated Acute Kidney Injury Subphenotypes.Critical care medicine · 2026Observational
- Serum renin levels refine acute kidney injury prediction in critically ill children.Pediatric nephrology (Berlin, Germany) · 2026Observational
- Renin-angiotensin system activation and oxidative stress in hospitalized COVID-19 patients: a single-centre prospective observational study.Intensive care medicine experimental · 2026Article
- Kidney-targeted nanoplatforms: Strategies and applications.Theranostics · 2026Review
- Alterations in the renin-angiotensin system during septic shock.Annals of intensive care · 2025Article
- Kinetics of Renin Concentrations in Infants Undergoing Congenital Cardiac Surgery.Journal of intensive care medicine · 2025Article
- Higher circulating ACE2 and DPP3 but reduced ACE and angiotensinogen in hyperreninemic sepsis patients.Clinical science (London, England : 1979) · 2025Article
- Circulating angiotensin-converting enzyme 2 concentration is associated with acute kidney injury and mortality in sepsis.PloS one · 2025Article
- The renin-angiotensin-aldosterone-system in sepsis and its clinical modulation with exogenous angiotensin II.Critical care (London, England) · 2024Review
- Alterations in the Renin-Angiotensin System in Experimental Septic Shock.Critical care explorations · 2024Article
- Impaired angiotensin II signaling in septic shock.Annals of intensive care · 2024Review
- Review
- The alternative renin-angiotensin system in critically ill patients: pathophysiology and therapeutic implications.Critical care (London, England) · 2023Review
- Utilization of Synthetic Human Angiotensin II for Catecholamine-Resistant Vasodilatory Shock in Critically Ill Children: A Single-Center Retrospective Case Series.Critical care explorations · 2023Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundSepsis-induced endothelial dysfunction is proposed to cause angiotensin-converting enzyme (ACE) dysfunction and renin-angiotensin-aldosterone system (RAAS) derangement, exacerbating vasodilatory shock and acute kidney injury (AKI). Few studies test this hypothesis directly, including none in children. We measured serum ACE concentrations and activity, and assessed their association with adverse kidney outcomes in pediatric septic shock.
methodsA pilot study of 72 subjects aged 1 week-18 years from an existing multicenter, observational study. Serum ACE concentrations and activity were measured on Day 1; renin + prorenin concentrations were available from a previous study. The associations between individual RAAS components and a composite outcome (Day 1-7 severe persistent AKI, kidney replacement therapy use, or mortality) were assessed.
results50/72 subjects (69%) had undetectable ACE activity (< 2.41 U/L) on Day 1 and 27/72 (38%) developed the composite outcome. Subjects with undetectable ACE activity had higher Day 1 renin + prorenin compared to those with activity (4533 vs. 2227 pg/ml, p = 0.017); ACE concentrations were no different between groups. Children with the composite outcome more commonly had undetectable ACE activity (85% vs. 65%, p = 0.025), and had higher Day 1 renin + prorenin (16,774 pg/ml vs. 3037 pg/ml, p < 0.001) and ACE concentrations (149 vs. 96 pg/ml, p = 0.019). On multivariable regression, increasing ACE concentrations (aOR 1.01, 95%CI 1.002-1.03, p = 0.015) and undetectable ACE activity (aOR 6.6, 95%CI 1.2-36.1, p = 0.031) retained associations with the composite outcome.
conclusionsACE activity is diminished in pediatric septic shock, appears uncoupled from ACE concentrations, and is associated with adverse kidney outcomes. Further study is needed to validate these findings in larger cohorts.
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