Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists

Neonatal acute kidney injury (AKI) is common. Critically ill neonates are at risk for AKI for many reasons including the severity of their underlying illnesses, prematurity, and nephrotoxic medications. In this educational review, we highlight four clinical scenarios in which both the illness itself...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) Vol. 35; no. 11; pp. 2077 - 2088
Main Authors: Murphy, Heidi J., Thomas, Brady, Van Wyk, Brynna, Tierney, Sarah B., Selewski, David T., Jetton, Jennifer G.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2020
Springer
Subjects:
Acute renal failure
Complications and side effects
Diseases
Educational Review
Infants (Newborn)
Medicine
Medicine & Public Health
Neonatal intensive care
Nephrology
Pediatric research
Pediatrics
Risk factors
Urology
What’s new in AKI
United States
Hypoxic ischemic encephalopathy
Necrotizing enterocolitis
Nonsteroidal anti-inflammatory drugs
Antibiotics
Patent ductus arteriosus
Neonatal sepsis
ISSN:0931-041X, 1432-198X, 1432-198X
Online Access:Get full text
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Summary:Neonatal acute kidney injury (AKI) is common. Critically ill neonates are at risk for AKI for many reasons including the severity of their underlying illnesses, prematurity, and nephrotoxic medications. In this educational review, we highlight four clinical scenarios in which both the illness itself and the medications indicated for their treatment are risk factors for AKI: sepsis, perinatal asphyxia, patent ductus arteriosus, and necrotizing enterocolitis. We review the available evidence regarding medications commonly used in the neonatal period with known nephrotoxic potential, including gentamicin, acyclovir, indomethacin, vancomycin, piperacillin–tazobactam, and amphotericin. We aim to illustrate the complexity of decision-making involved for both neonatologists and pediatric nephrologists when managing infants with these conditions and advocate for ongoing multidisciplinary collaboration in the development of better AKI surveillance protocols and AKI mitigation strategies to improve care for these vulnerable patients.
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ISSN:0931-041X
1432-198X
1432-198X
DOI:10.1007/s00467-019-04350-3