Drug misadventuring in neonatal nephrology.
Drug-related problems are associated with significant morbidity and mortality. Numerous factors contribute to the development of drug-related problems. These factors may be patient-dependent, such as the patient's degree of organ function and/or dysfunction, and underlying disease states. On the contrary the factors may depend on the specific drug and its pharmacokinetic parameters. Recently it has been also demonstrated the importance of genetic factors. Drug-related problems include a wide range of situations including the so-called drug misadventuring: adverse drug reaction (ADR), adverse drug event (ADE), drug-induced disorder (DID), adverse drug experience (ADEexp). Certain drug classes are commonly associated with drug-induced disorders. Antibiotics and chemotherapeutic agents are responsible for approximately 30 percent of all adverse reactions. By an epidemiologic point of view between 3% and 11% of hospital admissions could be attributed to drug-related problems. Drug-induced disorders have historically been classified as predictable (Type A) or unpredictable (Type B) toxicity. Thus, a substantial portion of drug-induced disorders are predictable and potentially avoidable The kidney is vulnerable to drugs because of its high blood flow and large capillary surface area, its role as the excretory route for many drugs and its detoxifying action. Drug-induced acute renal failure accounts for 20% of total cases of acute renal failure in adult patients. Little is known about epidemiology of drug-induced disorders, especially in the pediatric kidney. Systematic epidemiological data on the incidence of drug-induced acute renal failure in newborn are not available. However, an increase in the last 10 years, in the involvement of drugs in acute renal failure has been observed in newborns. In the past it was suggested that drug-induced kidney damage (especially tht caused by aminoglycosides or glycopeptides) is less frequent and severe in newborns than in adults. However, this subject is controversial. Furthermore, it has recently been confirmed that low birth weights contribute to early onset of end stage renal disease. In view of the extremely widespread use of drugs in neonatology and the multiplicity of potential nephrotoxic factors, it is important to prevent iatrogenic effects. Ten rules for prevention of drug-induced nephrotoxicity are presented.
Fanos
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Paediatric Department, University of Verona, Piazzale L.A. Scuro, Ospedale Policlinico, 37134, Verona, Italy. vafanos@tin.it
Cataldi
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D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000139:chemically induced*