Drugs and acute renal insufficiency in the neonate

Oliguria in the neonate usually reflects a fall in glomerular filtration rate (GFR) secondary to prerenal disturbances such as hypovolemia, hypotension, hypoxemia and cardiac failure, or to vasoactive drugs such as indomethacin and tolazoline. The action of such drugs on renal function is reviewed, as well as the pharmacological measures that can be tried to prevent or blunt their renal side effects. The efficacy and side effects of dopamine, furosemide and mannitol, frequently used in oliguric states due to either prerenal disturbances or to vasoactive drugs, are discussed. It is concluded that available data in newborn infants do not definitely prove the efficacy of dopamine and furosemide in preventing acute renal insufficiency and that, in neonates with established oliguria, administration of mannitol, dopamine and/or furosemide can be tried, with little hope, however, of markedly improving GFR.