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The interplay between drugs and the kidney in premature neonates

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Abstract

The kidney plays a central role in the clearance of drugs. However, renal drug handling entails more than glomerular filtration and includes tubular excretion and reabsorption, and intracellular metabolization by cellular enzyme systems, such as the Cytochrome P450 isoenzymes. All these processes show maturation from birth onwards, which is one of the reasons why drug dosing in children is not simply similar to dosing in small adults. As kidney development normally finishes around the 36th week of gestation, being born prematurely will result in even more immature renal drug handling. Environmental effects, such as extra-uterine growth restriction, sepsis, asphyxia, or drug treatments like caffeine, aminoglycosides, or non-steroidal anti-inflammatory drugs, may further hamper drug handling in the kidney. Dosing in preterm neonates is therefore dependent on many factors that need to be taken into account. Drug treatment may significantly hamper postnatal kidney development in preterm neonates, just like renal immaturity has an impact on drug handling. The restricted kidney development results in a lower number of nephrons that may have several long-term sequelae, such as hypertension, albuminuria, and renal failure. This review focuses on the interplay between drugs and the kidney in premature neonates.

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Acknowledgments

MFS is supported by the Dutch Kidney Foundation (KJPB.08.06). KA is supported by the Fund for Scientific Research, Flanders (Belgium) (FWO Vlaanderen, 1800214 N).

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Michiel F Schreuder & Ruud R G Bueters

  2. Department of Development and Regeneration, KU Leuven and, University Hospitals Leuven, Leuven, Belgium

    Karel Allegaert

  3. Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium

    Karel Allegaert

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  1. Michiel F Schreuder
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Schreuder, M.F., Bueters, R.R.G. & Allegaert, K. The interplay between drugs and the kidney in premature neonates. Pediatr Nephrol 29, 2083–2091 (2014). https://doi.org/10.1007/s00467-013-2651-0

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