The Effect of Bumetanide in Extremely Low Birth Weight Infants with Acute Kidney Injury during their first Weeks of Life

Merheb, Roula; Kruzer, Karen; Mhanna, Maroun J.

doi:10.15401/jcpn/2014/v2i1/50526

Cited by 8 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, in a retrospective case-control study, bumetanide was shown to improve the urine output of ELBW infants with AKI at the expense of increasing their SCr. 78 In another study, bumetanide was also shown to increase significantly the urine output, in premature infants with oliguric AKI, but at the expense of a transient increase in SCr. 79 Despite the lack of evidence in neonates, a trial of diuretics in oliguric neonates with AKI is warranted given the complexity of renal replacement therapy.…”

Section: Neonatal Cardiac Surgerymentioning

confidence: 95%

Neonatal Acute Kidney Injury

et al. 2015

Self Cite

View full text Add to dashboard Cite

In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

show abstract

Section: Neonatal Cardiac Surgerymentioning

confidence: 95%

Neonatal Acute Kidney Injury

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Monitoring markers of kidney function such as creatinine, electrolyte, fluid, weight, and acid-base status, careful attention to type and amount of intake, and addressing medication needs with choosing kidney friendly alternatives where possible, as well as monitoring drug levels of renally excreted drugs and reducing prescribed amounts adequately are commonly employed strategies (Table 2). The use of diuretics in oliguria may be a double-edged sword as the increase in urinary output is often offset by an increase in creatinine [70]. …”

Section: Reviewmentioning

confidence: 99%

Renal consequences of preterm birth

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

“…In a recent study of oliguric AKI in preterm infants, Oliveros et al found bumetanide more effective than furosemide for increasing urine output [48], but the results may have been biased by use of non-equivalent doses of furosemide and bumetanide [49]. Merheb et al similarly found that bumetanide effectively increased urine output in ELBW infants, but this was associated with an increase in serum creatinine [50]. Although the use of diuretics cannot be justified in terms of improved patient or renal survival, they can be helpful for fluid management if oliguric AKI can be converted to nonoliguric AKI.…”

Section: Diureticsmentioning

confidence: 99%

Therapeutic Options for Neonatal Acute Kidney Injury (AKI)

Mian

Askenazi

Mhanna

2016

Curr Treat Options Peds

Self Cite

View full text Add to dashboard Cite

Neonatal acute kidney injury (AKI) I Renal failure I CRRT I CVVH I Peritoneal dialysis I Renal support therapy I Fluid overload I Renal recovery I Dialysis I Theophylline I Nephrotoxic I Prevention I CARPEDIEM I NIDUS Opinion statement Acute kidney injury (AKI) occurs commonly in neonates and is associated with increased mortality. Recent advances in neonatal intensive care have resulted in improved patient survival, but this had not been paralleled by improved outcomes for neonates with AKI. Management of AKI remains supportive with no effective pharmacologic therapy to hasten the recovery process. Emphasis is placed on the prevention and minimization of further renal insults once AKI is established. Routine, regular assessments of renal function with identification of high risk patients and those with incipient AKI are essential so prevention strategies can be promptly initiated. Effective prevention strategies include prompt restoration/preservation of organ perfusion with fluid resuscitation to ensure an adequate effective circulating volume and inotropic support as needed to maintain hemodynamic stability while also avoiding/minimizing nephrotoxin exposure. In established AKI, efforts are focused on maintaining organ perfusion while closely monitoring cumulative fluid balance from admission and remaining cognizant of the need to minimize the degree of fluid overload as this has also been associated with poor outcomes. Continuous renal replacement therapy (CRRT) has become the preferred therapy for managing fluid overload and metabolic disturbances in critically ill children and adults but is still considered by many to be a heroic intervention for neonates due in large part to numerous technical challenges. The recent development of two miniaturized machines specifically designed to deliver CRRT and hemodialysis (HD) to neonates will hopefully change this paradigm making it easier for nephrologists and intensivists to safely offer and provide this therapy to neonates. Prospective studies are needed to assess whether early initiation of RRT with correction of fluid imbalance results in improved patient survival and renal recovery.

show abstract

The Effect of Bumetanide in Extremely Low Birth Weight Infants with Acute Kidney Injury during their first Weeks of Life

Cited by 8 publications

References 0 publications

Neonatal Acute Kidney Injury

Neonatal Acute Kidney Injury

Renal consequences of preterm birth

Therapeutic Options for Neonatal Acute Kidney Injury (AKI)

Contact Info

Product

Resources

About