[Renal function and pharmacotherapy in children]

This review discusses the effects of maturation and renal failure on drug disposition and describes drug-induced renal syndromes (nephrotoxicity). Infants and children have age-related differences in physiological and biochemical maturity that alter the pharmacokinetic properties of drugs. Pharmacokinetics are different at birth because of this adaptation period of organ function and because extracellular fluid volume is much larger relative to body size. Postnataly there is an increased in glomerular filtration rate, which reaches adult values at 1 to 2 years of age. Immaturity of tubular functions at birth and during first year of life also modifies the farmacokinetics of drugs. The kidney is the major route of elimination for many drugs and their metabolites. Decrease renal function leads to changes in the pharmacokinetic profiles of various drugs. Adjusting drug dosed in patients with renal failure requires estimates of renal function and the rate of drug elimination, based on the degree of renal impairment. This review provides guideline for the prescribing of drugs in children with end-stage renal disease. As the principal organ of excretion, the kidney is haevily exposed to a variety of foreign chemicals. Exposure is greater when ischemia and endotoxemia are present. This reviewe discusses a number of acute and chronic renal injuries related to drug therapy (nephrotoxicity), limiting discussion to the most commonly used medications. Brief consideration is also given to some important examples of immunologicaly mediated renal injury.