Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France.
Department of Biochemistry, University Hospital, Dijon, France.
Shock. 2019 Oct;52(4):e22-e30. doi: 10.1097/SHK.0000000000001285.
In septic shock, both systemic vasodilatation and glomerular arteriole dilatation are responsible for the drop in glomerular filtration observed in early acute kidney injury. Angiotensin II has been shown to act on both mechanisms. Our objective was to evaluate the impact of renin angiotensin system activation, on hemodynamic deficiency and renal outcome in patient with septic shock and to assess whether urinary sodium could be a reliable test for high plasma renin concentration screening.
This was a prospective and observational study. Inclusion criteria were early septic shock (first episode), dose of norepinephrine ≥ 0.25 μg/kg/min, before the start of substitutive corticosteroids. Plasma renin concentration, plasma aldosterone concentration, and urinary sodium were measured at inclusion. Renal outcome, organ deficiency, and 28-day survival were followed.
Plasma renin concentration was associated with worse hemodynamic deficiency and adverse renal outcome. Natriuresis was associated with shock severity but was not associated with renal outcome. Low natriuresis (< 20 mM) was associated with higher renin concentration. Those two variables were only weakly correlated.
Plasma renin concentration is associated with adverse renal outcome, probably through shock severity and insufficient glomerular efferent arterioles vasoconstriction. An association was observed between low natriuresis and high plasma renin concentration.
在感染性休克中，全身血管舒张和肾小球小动脉舒张都会导致肾小球滤过率下降，这是早期急性肾损伤的表现。血管紧张素 II 被证明可以作用于这两种机制。我们的目的是评估肾素-血管紧张素系统激活对感染性休克患者血流动力学不足和肾脏结局的影响，并评估尿钠是否可以作为高血浆肾素浓度筛查的可靠检测。
这是一项前瞻性观察性研究。纳入标准为早期感染性休克（首次发作），去甲肾上腺素剂量≥0.25μg/kg/min，在开始替代皮质激素之前。在纳入时测量血浆肾素浓度、血浆醛固酮浓度和尿钠。随访肾脏结局、器官功能障碍和 28 天存活率。
血浆肾素浓度与较差的血流动力学不足和不良的肾脏结局相关。尿钠排泄与休克严重程度相关，但与肾脏结局无关。低尿钠（<20mM）与高肾素浓度相关。这两个变量只有弱相关性。
血浆肾素浓度与不良的肾脏结局相关，可能通过休克严重程度和肾小球出球小动脉收缩不足。观察到低尿钠与高血浆肾素浓度之间存在关联。
