Research of angiotensin peptides levels in children with pre-dialysis chronic kidney disease

Chronic kidney disease (CKD) is a progressive disease characterized by irreversible decrease in glomerular filtration rate (GFR) for more than 3 months. The aim of our study was to compare the angiotensin peptide levels (angiotensin A, angiotensin 2, angiotensin 1-7, alamandine, angiotensin converting enzyme 1, angiotensin converting enzyme 2) of children with pre-dialysis CKD and to evaluate the relationship with cardiac function. Thirty-seven patients diagnosed with CKD at the Department of Pediatric Nephrology, Eskisehir Osmangazi University Faculty of Medicine and 48 children were included as control group. Serum and urine samples were analyzed for angiotensin peptides by ELISA. Echocardiographic imaging with M-mode, pulsed wave doppler, tissue doppler and speckle tracking strain was performed in the Department of Pediatric Cardiology. Of the children with CKD, 43,2% (n=16) were girls, whereas 39,5% (n=19) of the control group were girls(p>0,05). Congenital anomalies of the kidneys and urinary tracts (CAKUT) were found in 67,6% (n=25) of the patients. Serum angiotensin peptide levels were not significantly different between the patient and control groups (p>0,05), while urinary levels were lower in the patient group (p<0,001). Urinary angiotensin peptide levels were lower in the presence of hypertension (p<0.001). Urinary angiotensin peptide levels were lower as CKD stage progressed (p<0.001). Our study demonstrates alterations in RAAS (the renin angiotensin aldosterone system) in renal dysfunction, hypertension and cardiac involvement and supports the superiority of advanced echocardiographic methods over conventional echocardiography in detecting cardiac dysfunction.