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Nephrotoxicity as a cause of acute kidney injury in children

Ludwig Patzer1

  • 1Children's Hospital St. Elisabeth and St. Barbara, Mauerstrasse 5, 06110, Halle/S., Germany. patzer@krankenhaus-halle-saale.de

Pediatric Nephrology (Berlin, Germany)
|January 30, 2008
PubMed

Insights

Nephrotoxic drugs are a significant cause of acute kidney injury (AKI) in children, with factors like age and other medications influencing severity. Early identification and avoidance of nephrotoxic agents are crucial for prevention.

Area of Science:

  • Pediatric Nephrology
  • Clinical Pharmacology
  • Toxicology

Background:

  • Acute kidney injury (AKI) in children lacks defined incidence and etiology.
  • Pediatric intensive care unit (PICU) studies report AKI incidence between 8-30%, with neonates at higher risk.
  • Nephrotoxic drugs contribute to approximately 16% of pediatric AKI cases.

Purpose of the Study:

  • To review the causes, risk factors, and mechanisms of drug-induced nephrotoxicity in children.
  • To highlight the importance of identifying and managing nephrotoxic agents in pediatric AKI.

Main Methods:

  • Review of pediatric retrospective and prospective studies on AKI incidence.
  • Analysis of common nephrotoxic agents and their association with pediatric AKI.
  • Discussion of pathophysiological mechanisms of drug-induced kidney damage.

Main Results:

  • Nephrotoxic drugs are a common cause of AKI in children, particularly older children and adolescents.
  • Key nephrotoxic agents include NSAIDs, antibiotics, amphotericin B, ACE inhibitors, and radiocontrast media.
  • Mechanisms include intrarenal vasoconstriction, acute tubular necrosis, and interstitial nephritis.

Conclusions:

  • Drug-induced nephrotoxicity is a significant risk factor for AKI in children.
  • Predisposing factors like age, genetics, and concurrent medications influence AKI severity.
  • Management involves avoiding dehydration and co-administered nephrotoxic drugs, especially in children with pre-existing kidney issues.

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