miRNA in Septic Acute Kidney Injury

University Hospital Ostrava

Status: Enrolling

Conditions: Acute Kidney Injury Due to Sepsis; Acute Kidney Injury; Sepsis

Treatments: Diagnostic Test: Laboratory examination to determine miRNA and biochemical parameters; Diagnostic Test: Laboratory examination to determine the presence of sepsis and acute kidney injury; Diagnostic Test: Laboratory examination to determine the presence of sepsis

Study type: Observational

Funder types: Other

Identifiers

NCT06498336

RVO-FNOs/2024 (Other Grant/Funding Number)

INT-01-sepsis-miRNA

Details and patient eligibility

About

Acute kidney injury is a common and serious complication of sepsis and septic shock, which may be associated with a worse outcome of the patient's condition. The exact pathophysiological mechanism of septic acute kidney injury remains a challenge. One of the possible causes appears to be endothelial dysfunction and mitochondrial damage of renal tubular cells. The aim of this study is to identify specific microRNAs associated with these pathophysiological events in sepsis and septic acute kidney injury. And to establish a new potential diagnostic or therapeutic target for the prevention or treatment of septic acute kidney injury.

Full description

Sepsis is generally characterized as a life-threatening organ dysfunction and dysregulating host reaction to the infection (e.g., bacterial, viral, mycotic (1). Typical pathophysiological processes of sepsis include systemic inflammation, immune suppression, activation of the clotting cascade, and increase of endothelial vascular permeability with subsequent leak of fluids into the interstitial space. One of the most important organ damage due to ongoing sepsis is acute kidney injury (AKI), which is also a predictor of mortality in critically ill patients. The exact pathophysiology of septic AKI remains a challenging and poorly understood mechanism. A decrease of oxygen delivery to the tissues during the septic shock and usually high oxygen consumption of renal tubular cells make them prone to ischemia injury with consequences in tubular cell death. Among potential immune inflammatory response biomarkers in sepsis and septic shock might be promising pentraxin 3 (PTX3), which plays an important role in endothelial dysfunction with several pathogenic pathways' activation. Recently has been shown the positive effect of PTX3 on the inhibition of reactive oxygen species, mitochondrial injury, and apoptosis pathway in AKI (3,4). Another promising urinary or serum biomarker of AKI seems to be uromodulin, which is dynamically regulated in response to sepsis. Serum uromodulin concentrations decrease during septic human AKI development and are associated with increased renal and systemic oxidative damage (5,6,7). MicroRNAs are small non-coding RNAs, that have been reported to be useful biomarkers for AKI development or potential target for AKI treatment. Determination of serum PTX3 and uromodulin concomitantly with specific circulating miRNAs associated with PTX3 and uromodulin-specific signaling pathways in critically ill septic patients could bring new insights to septic AKI pathophysiology and contribute to future development of new preventive or therapeutic options in septic patients.

Enrollment: 220 estimated patients

Sex: All

Ages: 18 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

The study group of patients with sepsis with or without acute kidney injury

• age > 18 years
• newly diagnosed sepsis or septic shock with or without acute kidney injury

Healthy volunteers

• no evidence of infection on clinical or laboratory examination
• age > 18 years
• signed informed consent

Exclusion criteria

The study group of patients with sepsis with or without acute kidney injury

• age < 18 years
• chronic kidney disease at stage 4 or 5 according to KDIGO recommendations (KDIGO) for chronic kidney disease 2024
• patients on chronic dialysis treatment, or after renal transplantation

Healthy volunteers

• acute or chronic infection
• renal disease

Trial design

220 participants in 3 patient groups

Critically ill adult septic patients without acute kidney injury

Description:

The patients in this group will be screened clinically and by standard laboratory biochemical methods to determine sepsis diagnosis according to SEPSIS 3 (1). Blood samples for obtaining serum/plasma of the patients will be taken on the 1st and 4th day of sepsis diagnosis.

Treatment:

Diagnostic Test: Laboratory examination to determine the presence of sepsis

Critically ill adult septic patients with acute kidney injury

Description:

The patients will be screened clinically and by standard laboratory biochemical methods to determine sepsis diagnosis according to SEPSIS 3 and acute kidney injury according to KDIGO 2012 (2). Blood samples for obtaining serum/plasma of the patients will be taken on the 1st and 4th day of sepsis diagnosis.

Treatment:

Diagnostic Test: Laboratory examination to determine the presence of sepsis and acute kidney injury

Healthy volunteers

Description:

The blood samples for miRNA and biochemical parameters will be collected once, after randomization.

Treatment:

Diagnostic Test: Laboratory examination to determine miRNA and biochemical parameters