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Drug misadventuring in neonatal nephrology.

V Fanos1, L Cataldi

  • 1Paediatric Department, University of Verona, Piazzale L.A. Scuro, Ospedale Policlinico, 37134, Verona, Italy. vafanos@tin.it

La Pediatria Medica E Chirurgica : Medical and Surgical Pediatrics
|May 4, 2002
PubMed
Summary

Drug-related problems cause significant harm, with kidneys being particularly vulnerable. This study highlights the need for preventative measures against drug-induced kidney damage, especially in newborns.

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Area of Science:

  • Pharmacology
  • Nephrology
  • Pediatrics

Background:

  • Drug-related problems contribute significantly to morbidity and mortality, stemming from patient-dependent factors (organ function, disease states), drug properties (pharmacokinetics), and genetic influences.
  • Drug-induced disorders encompass adverse drug reactions (ADR), adverse drug events (ADE), and drug-induced disorders (DID), with antibiotics and chemotherapy agents causing approximately 30% of adverse reactions.
  • The kidney's high blood flow, large capillary surface area, and role in drug excretion and detoxification make it susceptible to drug-induced damage, accounting for 20% of adult acute renal failure.

Purpose of the Study:

  • To investigate the epidemiology of drug-induced disorders, with a specific focus on pediatric kidney involvement.
  • To address the lack of systematic epidemiological data on drug-induced acute renal failure in newborns.

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  • To emphasize the importance of preventing iatrogenic effects in neonatology due to widespread drug use and multiple nephrotoxic factors.

    • Main Methods:

    • Review of existing literature on drug-related problems and their impact on kidney function.
    • Analysis of epidemiological data concerning drug-induced acute renal failure in adult and pediatric populations.
    • Identification of potential nephrotoxic factors and risk contributors in neonates, including low birth weight.

    Main Results:

    • While data on drug-induced acute renal failure in newborns is scarce, an increasing trend in drug involvement has been observed over the past decade.
    • The notion that drug-induced kidney damage is less frequent or severe in newborns compared to adults is controversial and requires further investigation.
    • Low birth weight is a confirmed contributing factor to the early onset of end-stage renal disease.

    Conclusions:

    • Drug-induced nephrotoxicity is a significant concern, particularly in the vulnerable neonatal population.
    • Preventative strategies are crucial given the extensive use of medications in neonatology and the multiplicity of nephrotoxic risks.
    • Ten rules for the prevention of drug-induced nephrotoxicity are presented to mitigate iatrogenic effects.