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Ontogeny of drug elimination by the human kidney

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Abstract

Renal clearance is an important route of drug elimination. While during the neonatal period there is minimal glomerular filtration and active tubular secretion of drugs, there is a well-described rapid development in these processes in the post-neonatal period. A less appreciated fact is that during toddlerhood, there is an “overshoot” of the glomerular filtration rate (GFR) well above the levels encountered in older children and adults, and there is an early achievement of adult levels in active drug secretion, which stays at a plateau throughout childhood and adulthood with an “overshoot” in toddlers due to specific transport mechanisms. This phenomenon leads to dose requirements for renally excreted drugs in this age group being, on a per-kilogram basis, much larger than in adults. This review discusses the mechanisms related to renal ontogeny in drug handling.

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Acknowledgements

This study was supported by a grant of Canadian Institutes Health Research (CIHR) and by the Ivey Chair in Molecular Toxicology, University of Western Ontario, London, Ontario.

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Authors and Affiliations

  1. Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, Medical Sciences Building Rm 242D, London, Ontario, N6A 5C1, Canada

    Nancy Chen & Gideon Koren

  2. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada

    Katarina Aleksa, Cindy Woodland & Gideon Koren

  3. Department of Pharmacology, Faculty of Medicine, University of Toronto , Ontario, Toronto, Canada

    Cindy Woodland

  4. Department of Physiology and Pharmacology and Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada

    Michael Rieder

  5. Department of Pediatrics, Children’s Hospital of Western Ontario, London, Ontario, Canada

    Michael Rieder

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  1. Nancy Chen
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  2. Katarina Aleksa
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  3. Cindy Woodland
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  5. Gideon Koren
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Correspondence to Gideon Koren.

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Gideon Koren is the CIHR senior scientist

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Chen, N., Aleksa, K., Woodland, C. et al. Ontogeny of drug elimination by the human kidney. Pediatr Nephrol 21, 160–168 (2006). https://doi.org/10.1007/s00467-005-2105-4

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