NSAIDs, prostaglandins and the neonatal kidney
- 1 January 2009
- journal article
- review article
- Published by Informa UK Limited in The Journal of Maternal-Fetal & Neonatal Medicine
- Vol. 22 (sup3), 23-26
- https://doi.org/10.1080/14767050903184447
Abstract
Renal prostaglandins, particularly PGE(2), play a homeostatic role in the immature kidney through their hemodynamic and tubular effects, and this role may be crucial under conditions of renal stress. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the neonatal period to treat or prevent patent ductus arteriosus (PDA) in preterm infants. The nephrotoxic effects induced by NSAIDs result from the inhibition of renal cyclooxygenase activity and prostaglandin synthesis. NSAID-induced prostaglandin inhibition may result in renal hypoperfusion and acute renal failure which are clinically relevant, but usually reversible, adverse effects in the newborn. Currently, ibuprofen appears to be the therapeutic option of choice in the preterm newborn with PDA because of its better renal tolerability compared to other NSAIDs. Nevertheless, the use of this drug is not free from adverse renal effects, particularly in circumstances when renal prostaglandin activation is maximal. The implementation of measures to prevent or minimise nephrotoxicity and close monitoring of renal function are mandatory in the newborn treated with NSAIDs. The measurement of urinary PGE(2) may represent a non-invasive and sensitive tool to evaluate renal function, and thus should be implemented in the clinical management of newborns exposed to nephrotoxic insults.Keywords
This publication has 22 references indexed in Scilit:
- Urinary prostaglandin E2 in the newborn and infantProstaglandins & Other Lipid Mediators, 2007
- Renal effects of ibuprofen for the treatment of patent ductus arteriosus in premature infantsThe Journal of Maternal-Fetal & Neonatal Medicine, 2007
- Impact of ibuprofen administration on renal drug clearance in the first weeks of lifeMethods and Findings in Experimental and Clinical Pharmacology, 2006
- A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosusEuropean Journal of Pediatrics, 2004
- Indomethacin and renal impairment in neonatesPediatric Nephrology, 2004
- Histomorphometric Analysis of Postnatal Glomerulogenesis in Extremely Preterm InfantsPediatric and Developmental Pathology, 2004
- Renal follow up of premature infants with and without perinatal indomethacin exposureArchives of Disease in Childhood: Fetal & Neonatal, 2001
- NSAID-Induced Nephrotoxicity from the Fetus to the ChildDrug Safety, 2001
- A Comparison of Ibuprofen and Indomethacin for Closure of Patent Ductus ArteriosusNew England Journal of Medicine, 2000
- Effect of low-dose dopamine infusion on urinary prostaglandin E2 excretion in sick, preterm infantsEuropean Journal of Pediatrics, 1988