The interplay between drugs and the kidney in premature neonates

Michiel F. Schreuder*, Ruud R.G. Bueters, Karel Allegaert

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

31 Citations (Scopus)

Abstract

The kidney plays a central role in the clearance of drugs. However, renal drug handling entails more than glomerular filtration and includes tubular excretion and reabsorption, and intracellular metabolization by cellular enzyme systems, such as the Cytochrome P450 isoenzymes. All these processes show maturation from birth onwards, which is one of the reasons why drug dosing in children is not simply similar to dosing in small adults. As kidney development normally finishes around the 36th week of gestation, being born prematurely will result in even more immature renal drug handling. Environmental effects, such as extra-uterine growth restriction, sepsis, asphyxia, or drug treatments like caffeine, aminoglycosides, or non-steroidal anti-inflammatory drugs, may further hamper drug handling in the kidney. Dosing in preterm neonates is therefore dependent on many factors that need to be taken into account. Drug treatment may significantly hamper postnatal kidney development in preterm neonates, just like renal immaturity has an impact on drug handling. The restricted kidney development results in a lower number of nephrons that may have several long-term sequelae, such as hypertension, albuminuria, and renal failure. This review focuses on the interplay between drugs and the kidney in premature neonates.

Original languageEnglish
Pages (from-to)2083-2091
Number of pages9
JournalPediatric Nephrology
Volume29
Issue number11
DOIs
Publication statusPublished - 12 Nov 2014
Externally publishedYes

Bibliographical note

Funding Information:
MFS is supported by the Dutch Kidney Foundation (KJPB.08.06). KA is supported by the Fund for Scientific Research, Flanders (Belgium) (FWO Vlaanderen, 1800214 N).

Publisher Copyright:
© 2013, IPNA.

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