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Handling of Drugs in Children with Abnormal Renal Function-

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Pediatric Nephrology

Abstract

Every pediatrician must be able to administer the correct dosage for a variety of drugs across a wide array of patients: from a prematurely born baby weighing only 500 g to a large adolescent whose weight may exceed 120 kg. As a result, knowledge concerning changes in drug disposition as a result of childhood development is extremely important. An exceptional outline of the many changes that occur during human development that may alter drug disposition was published by Kearns et al. [1]. The changes his team listed include (i) changes in the integumentary development; (ii) changes in the volume of distribution (newborns have the highest total body water volume); (iii) changes in gastrointestinal function, hydrochloric acid production, and bile acid excretion; (iv) changes in the metabolic capacity of key enzymes; and, of course, (v) the acquisition of renal function. The effect of these changes can be so profound that an infant may metabolize a drug ten times faster than an adult and may form completely different metabolites. A study conducted by our team recently demonstrated such a disparity in the way that sirolimus is metabolized, finding a half-life of 72 h in adults and a half-life as short as 7 h in young children [2]. Moreover, the metabolite patterns in both groups were diametrically different [3].

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Acknowledgments

The authors thank Ms. Janice Sumpton, Pharmacist at Children’s Hospital, London Health Sciences Centre, for her extensive review of the drug tables. We also thank Ms. Marta Kobrzynski, research assistant to GF, for her expert editing.

Author information

Authors and Affiliations

  1. Departments of Pediatrics, Medicine, and Pathology Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Guido Filler

  2. Children’s Hospital of Western Ontario, Children’s Health Research Institute (CHRI), London, ON, Canada

    Guido Filler

  3. Departments of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Amrit Kirpalani

  4. Departments of Pediatrics, Department of Medicine, Physiology & Pharmacology, Western University, London, ON, Canada

    Bradley L. Urquhart

  5. Children’s Health Research Institute (CHRI), London, ON, Canada

    Bradley L. Urquhart

Authors
  1. Guido Filler
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  2. Amrit Kirpalani
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  3. Bradley L. Urquhart
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Corresponding author

Correspondence to Guido Filler .

Editor information

Editors and Affiliations

  1. Children's Hospital of Wisconsin Children's Research Institute, Milwaukee, Wisconsin, USA

    Ellis D. Avner

  2. Harvard Medical School Children's Hospital Boston, Boston, Massachusetts, USA

    William E. Harmon

  3. Hôpital Necker Enfants Malades Dept. Néphrologie Pédiatrique, Paris, France

    Patrick Niaudet

  4. Wakayama Medical University Dept. Pediatrics, Wakayama City, Japan

    Norishige Yoshikawa

  5. Department of Nephrology and Urology Division of Nephrology, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy

    Francesco Emma

  6. Division of Nephrology and Hypertension The Heart Institute, University of Cincinnati Cincinnati Children’s Hospital Medical C, Cincinnati, Ohio, USA

    Stuart Goldstein

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Filler, G., Kirpalani, A., Urquhart, B.L. (2015). Handling of Drugs in Children with Abnormal Renal Function-. In: Avner, E., Harmon, W., Niaudet, P., Yoshikawa, N., Emma, F., Goldstein, S. (eds) Pediatric Nephrology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27843-3_83-1

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