Long-term effects of neonatal drugs on the kidney

Zaffanello, Marco; Bassareo, Pier Paolo; Cataldi, L; Antonucci, Roberto; Biban, Paolo; Fanos, Vassilios

doi:10.3109/14767058.2010.501156

Cited by 33 publications

(20 citation statements)

References 21 publications

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“…The identification of only a few drugs associated with AKI lends support to the hypothesis that individual medication exposure may not be as important a risk factor for AKI as multiple medication exposure. A few studies have revealed nephrotoxic medication groups such as NSAIDs, antibiotics, ACE inhibitors, chemotherapeutics, and diuretics [9,[25][26][27]. Within our study population we could find evidence that some of the above-mentioned drug groups are indeed involved in the development of AKI.…”

Section: Discussionmentioning

confidence: 73%

Drugs as risk factors of acute kidney injury in critically ill children

et al. 2015

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Section: Discussionmentioning

confidence: 73%

Drugs as risk factors of acute kidney injury in critically ill children

et al. 2015

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“…Despite limited studies to support its use, diuretics are commonly used to reduce ventilatory and oxygen requirements, and methylxanthines like caffeine are ubiquitous, due to the proposed beneficial short and long-term effects on respiratory and developmental status [42]. All of these can be associated with AKI with potentially long-term deleterious effects in summation [43]. …”

Section: Reviewmentioning

confidence: 99%

Renal consequences of preterm birth

et al. 2017

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BackgroundThe developmental origin of health and disease concept identifies the brain, cardiovascular, liver, and kidney systems as targets of fetal adverse programming with adult consequences. As the limits of viability in premature infants have been pushed to lower gestational ages, the long-term impact of prematurity on kidneys still remains a significant burden during hospital stay and beyond.ObjectivesThe purpose of this study is to summarize available evidence, mechanisms, and short- and long-term renal consequences of prematurity and identify nephroprotective strategies and areas of uncertainty.ResultsKidney size and nephron number are known to be reduced in surviving premature infants due to disruption of organogenesis at a crucial developmental time point. Inflammation, hyperoxia, and antiangiogenic factors play a role in epigenetic conditioning with potential life-long consequences. Additional kidney injury from hypoperfusion and nephrotoxicity results in structural and functional changes over time which are often unnoticed. Nephropathy of prematurity and acute kidney injury confound glomerular and tubular maturation of preterm kidneys. Kidney protective strategies may ameliorate growth failure and suboptimal neurodevelopmental outcomes in the short term. In later life, subclinical chronic renal disease may progress, even in asymptomatic survivors.ConclusionAwareness of renal implications of therapeutic interventions and renal conservation efforts may lead to a variety of short and long-term benefits. Adequate monitoring and supplementation of microelement losses, gathering improved data on renal handling, and exploration of new avenues such as reliable markers of injury and new therapeutic strategies in contemporary populations, as well as long-term follow-up of renal function, is warranted.

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“…This suggests that the abnormalities may not have occurred as a result of preterm birth per se, but are likely related to factors in their postnatal care, which varied between individual neonates. For example, neonatal exposure to nephrotoxic medications (such as non-steroidal anti-inflammatory drugs and antibiotics) has been associated with both structural and functional renal injury [38]. However, a specific factor attributing to the abnormal glomeruli has not yet been established.…”

Section: The Effects Of Preterm Birth On Renal Developmentmentioning

confidence: 99%

Stereological Assessment of Renal Development in a Baboon Model of Preterm Birth

2011

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At the time when most preterm babies are delivered, nephrogenesis is still ongoing, with the majority of nephrons normally formed during the third trimester of pregnancy. The extrauterine environment, however, is suboptimal for organogenesis, and therefore renal development is likely to be adversely affected by preterm birth. In the long-term, there is emerging evidence of high blood pressure and renal dysfunction amongst young adults born preterm. There is little knowledge to date, however, regarding the effects of preterm birth on renal structural development, perhaps due to the lack of an appropriate animal model. We have demonstrated that the baboon (Papio sp.) has a similar time course of nephrogenesis as the human kidney, and the baboon neonate can also be cared for in the same manner as a human neonate following preterm birth. Through a series of studies assessing renal development in the baboon model of preterm birth, involving the use of gold-standard stereological techniques, we have demonstrated that nephron endowment in the preterm baboon kidney is not reduced. Furthermore, antenatal glucocorticoid exposure prior to preterm delivery was associated with an increase in mature nephrons. There was, however, evidence of morphological abnormalities in a variable percentage of the glomeruli formed ex utero. Further research is therefore essential in order to establish what factors are involved in contributing to the glomerular abnormalities, and to identify ways in which ‘normal’ renal development can be conserved and optimised in the extrauterine setting.

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Long-term effects of neonatal drugs on the kidney

Cited by 33 publications

References 21 publications

Drugs as risk factors of acute kidney injury in critically ill children

Drugs as risk factors of acute kidney injury in critically ill children

Renal consequences of preterm birth

Stereological Assessment of Renal Development in a Baboon Model of Preterm Birth

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