Plenary Lecture
Drug-Induced Nephrotoxicity in the Newborn: The State of
the Art
Professor Vassilios Fanos
Pediatrics University of Cagliari -Italy
Chief Neonatal Intensive Care Unit, Puericultura
Institute and
Neonatal Section
University of Cagliari, Italy
Secretary Italian Society of Neonatology
Italian Delegate Parliament of UENPS (Union European
Neonatal Perinatal Societies)
Executive Board Member UMENS (Union MEditerranean
Neonatal Societies)
E-mail:
vafanos@tiscali.it
Abstract:
Drug-induced kidney disease is
frequent in all age groups (1). In
adult patients nephrotoxicity has
been related to 8-60% of
in-hospital acute kidney injury.
Little is known about the
epidemiology of drug-induced
disorders in the paediatric
kidney. Drugs have also been found
to be involved in 50% of cases of
acute kidney injury in premature
newborn. The effects of maternally
administered drugs on the fetal
and neonatal kidney have been well
documented. Recent data suggest in
preterm neonates a significant
role for maternal consumption and
postnatal administration of
nonsteroidal anti-inflammatory
drugs (NSAIDs) in preterm infants.
In the past it was suggested that
drug-induced kidney damage
(especially that caused by
aminoglycosides or glycopeptides)
is less frequent and severe in
newborns than in children and
adults. However, this subject is
controversal and indeed neonatal
status may itself be a risk factor
for drug-induced nephrotoxicity.
In fact, it has been confirmed
that low birthweight contributes
to development of renal disease
also later in life
The actual importance of drugs as
causes of nephrotoxicity is not
easy to define: the drugs are
administered to newborns who are
sick and often seriously ill, who
present haemodinamic abnormalities
and/or electrolyte derangements.
All these situations may be
important co-factors in bringing
about the renal damage
Discussion of drug-induced
nephrotoxicity must consider the
following points: a drug may give
rise to renal damage in different
parts of the nephron and different
drugs can have the same
intracellular target. The proximal
tubule is generally to be regarded
as the target structure.
By a practical point of view it is
very important the correct
assessment and early diagnosis of
nephrotoxicity.
Aim of this review is to present a
comprehensive update on
drug-induced nephrotoxicity in the
newborn, with special reference to
antibiotics and NSAIDs.
Brief Biography of the Speaker:
Chief Neonatal Intensive Care
Unit, Neonatal Pathology,
Puericultura Institute and
Neonatal Section University of
Cagliari – and Azienda Mista
Cagliari, Italy
Treasurer Italian Society of
Neonatology (Secretary for 6
years)
Italian Delegate Parliament of
UENPS (Union European Neonatal
Perinatal Societies)
Executive Board Member UMENS
(Union MEditerranean Neonatal
Societies)
Consultant Referee of 15
International Journals and Board
member of 3.
Publications: Author of more than
500 publications (of which 122
papers in Pub Med, including
Lancet), 10 books on Neonatology
(2 in English: the first published
book on Neonatal Nephrology and
another on the History of Birth )
and 7 Proceedings of Congresses (4
in English)
Speaker in more than 200
Congresses (50 International).
Chairman in several International
Congresses; organizer of more than
50 Congresses and Workshops,
International.
Area of scientific interest:
neonatology, pharmacology,
infections, nephrology.
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