title: Drug-induced renal damage in preterm neonates: state of the art and methods for early detection.
abstract: Only a small fraction of drugs widely used in neonatal intensive care units (NICU) are specifically authorized for this population. Even if unlicensed or off-label use is necessary, it is associated with increased adverse drug reactions, which must be carefully weighed against expected benefits. In particular, renal damage is frequent among preterm babies, and is considered a predisposing factor for the development of chronic kidney disease in adulthood. Apart from specific conditions affecting premature neonates (e.g. respiratory distress syndrome, perinatal asphyxia), drugs play an important role in impairing renal function because of well-known nephrotoxicity and/or interaction with renal developmental factors. From a review of the available studies on drug use in NICU patients, we identified and described the most commonly administered drugs that are correlated to renal damage. Early detection of kidney injury is becoming an essential aspects for clinicians because of the limited number of biomarkers applicable in the neonatal population. Postnatal changes of biochemical processes that influence pharmacokinetic and pharmacodynamic aspects need to be further investigated in order to better understand the mechanisms of drug toxicity in this population. The most promising strategies for dose adjustment and therapeutic schemes are discussed. The purpose of this review was to describe current knowledge on drug use among premature babies and their implication in kidney injury development, as well as to highlight available strategies for early detection of renal damage.
authors: Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy.
authors: Anna
authors: A
authors: Girardi
authors: Emanuel
authors: E
authors: Raschi
authors: Silvia
authors: S
authors: Galletti
authors: Elisabetta
authors: E
authors: Poluzzi
authors: Giacomo
authors: G
authors: Faldella
authors: Karel
authors: K
authors: Allegaert
authors: Fabrizio
authors: F
authors: De Ponti
mesh_terms: D042241:Early Diagnosis; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000139:chemically induced* / Q000175:diagnosis; D007363:Intensive Care Units, Neonatal; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis; D056687:Off-Label Use