Plenary Lecture

Plenary Lecture

Drug-Induced Nephrotoxicity in the Newborn: The State of the Art

Professor Vassilios Fanos
Pediatrics University of Cagliari -Italy
Chief Neonatal Intensive Care Unit, Puericultura Institute and
Neonatal Section
University of Cagliari, Italy
Secretary Italian Society of Neonatology
Italian Delegate Parliament of UENPS (Union European Neonatal Perinatal Societies)
Executive Board Member UMENS (Union MEditerranean Neonatal Societies)

Drug-induced kidney disease is frequent in all age groups (1). In adult patients nephrotoxicity has been related to 8-60% of in-hospital acute kidney injury. Little is known about the epidemiology of drug-induced disorders in the paediatric kidney. Drugs have also been found to be involved in 50% of cases of acute kidney injury in premature newborn. The effects of maternally administered drugs on the fetal and neonatal kidney have been well documented. Recent data suggest in preterm neonates a significant role for maternal consumption and postnatal administration of nonsteroidal anti-inflammatory drugs (NSAIDs) in preterm infants.
In the past it was suggested that drug-induced kidney damage (especially that caused by aminoglycosides or glycopeptides) is less frequent and severe in newborns than in children and adults. However, this subject is controversal and indeed neonatal status may itself be a risk factor for drug-induced nephrotoxicity. In fact, it has been confirmed that low birthweight contributes to development of renal disease also later in life
The actual importance of drugs as causes of nephrotoxicity is not easy to define: the drugs are administered to newborns who are sick and often seriously ill, who present haemodinamic abnormalities and/or electrolyte derangements. All these situations may be important co-factors in bringing about the renal damage
Discussion of drug-induced nephrotoxicity must consider the following points: a drug may give rise to renal damage in different parts of the nephron and different drugs can have the same intracellular target. The proximal tubule is generally to be regarded as the target structure.
By a practical point of view it is very important the correct assessment and early diagnosis of nephrotoxicity.
Aim of this review is to present a comprehensive update on drug-induced nephrotoxicity in the newborn, with special reference to antibiotics and NSAIDs.

Brief Biography of the Speaker:
Chief Neonatal Intensive Care Unit, Neonatal Pathology, Puericultura Institute and Neonatal Section University of Cagliari and Azienda Mista Cagliari, Italy
Treasurer Italian Society of Neonatology (Secretary for 6 years)
Italian Delegate Parliament of UENPS (Union European Neonatal Perinatal Societies)
Executive Board Member UMENS (Union MEditerranean Neonatal Societies)
Consultant Referee of 15 International Journals and Board member of 3.
Publications: Author of more than 500 publications (of which 122 papers in Pub Med, including Lancet), 10 books on Neonatology (2 in English: the first published book on Neonatal Nephrology and another on the History of Birth ) and 7 Proceedings of Congresses (4 in English)
Speaker in more than 200 Congresses (50 International). Chairman in several International Congresses; organizer of more than 50 Congresses and Workshops, International.
Area of scientific interest: neonatology, pharmacology, infections, nephrology.



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