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Background  Acute kidney injury (AKI) is a multifactorial syndrome, but knowledge about its pathophysiology and possible genetic background is limited. Recently the first hypothesis-free genetic association studies have been published to explore individual susceptibility to AKI. We aimed to replicate the previously identified associations between five candidate single nucleotide polymorphisms (SNP) in apoptosis-related genes  BCL2, SERPINA4, SERPINA5 , and  SIK3  and the development of AKI, using a prospective cohort of critically ill patients with sepsis/septic shock, in Finland.    Methods  This is a prospective, observational multicenter study. Of 2567 patients without chronic kidney disease and with genetic samples included in the Finnish Acute Kidney Injury (FINNAKI) study, 837 patients had sepsis and 627 patients had septic shock. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, considering stages 2 and 3 affected (severe AKI), stage 0 unaffected, and stage 1 indecisive. Genotyping was done using iPLEX TM  Assay (Agena Bioscience). The genotyped SNPs were rs8094315 and rs12457893 in the intron of the  BCL2  gene, rs2093266 in the  SERPINA4  gene, rs1955656 in the  SERPINA5  gene and rs625145 in the  SIK3  gene. Association analyses were performed using logistic regression with PLINK software.    Results  We found no significant associations between the SNPs and severe AKI in patients with sepsis/septic shock, even after adjustment for confounders. Among patients with septic shock (252 with severe AKI and 226 without AKI (149 with KDIGO stage 1 excluded)), the SNPs rs2093266 and rs1955656 were significantly (odds ratio 0.63,  p  = 0.04276) associated with stage 2–3 AKI after adjusting for clinical and demographic variables.    Conclusions  The SNPs rs2093266 in the  SERPINA4  and rs1955656 in the  SERPINA5  were associated with the development of severe AKI (KDIGO stage 2–3) in critically ill patients with septic shock. For the other SNPs, we did not confirm the previously reported associations.    Electronic supplementary material  The online version of this article (doi:10.1186/s13054-017-1631-3) contains supplementary material, which is available to authorized users.

Genetic variants in SERPINA4 and SERPINA5, but not BCL2 and SIK3 are associated with acute kidney injury in critically ill patients with septic shock