Development of the endocrine function of the kidney

The kidney is a complex endocrine organ, and many of the renal hormones have actions that help regulate renal function. Although we have much more to learn about the role of most of these hormones in the regulation of renal function in both the newborn and adult kidney, there are some important aspects to keep in mind as we approach therapeutic interventions in sick newborn and premature infants. Because of the many interactions between hormonal systems, drugs that we may use for specific actions on one system may have effects on others as well (ACE inhibitors, cyclooxygenase inhibitors, dopamine antagonists). In addition, it is clear that the state of the organism may play a role in which of the renal hormones is active. Finally, the nonrenal hormonal systems that affect renal function (aldosterone, atrial natriuretic peptide, vasopressin, etc) may interact to change further expected results of any therapeutic intervention. Therefore, it behooves the clinician to monitor carefully renal function whenever modifications in therapy are made, whether it is a change in mechanical or pharmacologic intervention.