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Plasma Renin Concentration is Associated With Hemodynamic Deficiency and Adverse Renal Outcome in Septic Shock

Nguyen, Maxime*; Denimal, Damien†,‡; Dargent, Auguste§,||,¶; Guinot, Pierre-Grégoire*; Duvillard, Laurence†,‡; Quenot, Jean-Pierre§,||,¶; Bouhemad, Bélaïd*,§

doi: 10.1097/SHK.0000000000001285
Online Articles

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

*Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France

Department of Biochemistry, University Hospital, Dijon, France

National Institut of Health and Medical Research (INSERM) Unit 866, University Bourgogne, Franche Comté, Dijon, France

§Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France

||INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France

Department of Intensive Care, François Mitterrand University Hospital, Dijon, France

Address reprint requests to Maxime Nguyen, MD, Service d’Anesthésie Réanimation CHU Dijon, 21000 Dijon, France. E-mail:

Received 22 August, 2018

Revised 1 October, 2018

Accepted 29 October, 2018

MN, P-GG, and BB prepared the manuscript and collected the data. J-PQ and AD collected the data. DD and LD realized the dosages. Support was provided solely from departmental sources.

The authors report no conflicts of interest.

© 2019 by the Shock Society