[Aggression to the immature kidney].
The main causes for acute renal failure (ARF) in the newborn include endogenous factors (such as hypotension, hypovolemia, hypoxemia, perinatal asphyxia, and neonatal septicemia) and exogenous factors such as mechanical ventilation, nephrotoxic agents (antibiotics, indomethacin, ibuprofen, angiotensin converting enzyme inhibitors, and tolazoline). These conditions determinate vasoactive disturbances interfering with the delicate balance of intrarenal vasoconstrictor and vasodilator forces, which regulates the glomerular filtration rate (GFR) in the healthy term, and particularly in the premature infant. Factors influencing renal prognosis are the severity of the underlying disorder, the rapidity of an accurate diagnosis, prompt treatment, and avoidance of severe iatrogenic complications. Plasma creatinine concentrations should be used with some caution for ARF diagnosis in the first days of life. General measures of kidney protection include correcting abnormalities in fluid homeostasis, adequate ventilation and rational choice of drugs. Moreover, in order to protect the kidney, different compounds have been proposed such as diuretics (furosemide and torasemide), and dopaminergic agents (dopamine, dopexamine). With the increasing knowledge of the mechanisms governing the development of ARF, progress has been made in the development of new treatment modalities. For example theophylline, calcium antagonists, ATP-MgCl2, thyroxine, and antibodies against endothelin may in the near future be used to prevent or ameliorate the prognosis of the neonatal stressed kidney. The main renal replacement therapies are possible in the newborn. However preventive measures are easily available in the neonatal period and they often represent the most efficacious procedures.
Guignard
J P
JP
Département médico-chirurgical de Pédiatrie, CHUV, 1011 Lausanne, Suisse.
D005260:Female; D005325:Fetal Organ Maturity; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000196:embryology*; D007674:Kidney Diseases / Q000196:embryology / Q000209:etiology* / Q000517:prevention & control; D018811:Maternal Exposure