The Neonatal Kidney: Implications for Drug Metabolism and Elimination
I. Ligi, F. Boubred, I. Grandvuillemin and U. Simeoni
Affiliation: Division of Neonatology, La Conception Hospital, AP-HM, 147 Boulevard Baille, 13385 Marseille Cedex 5, France.
Keywords: Drug elimination, glomerular filtration, neonatal kidney, renal clearance, tubular secretion, Neonatal Kidney, Drug, Metabolism, Elimination, Metanephros, RBF, Juxtamedullary, Angiotensin II, COX
The kidney is a major organ for drug elimination. The function of the neonatal kidney is markedly immature with a reduction
of renal blood flow, of glomerular filtration and of active tubular secretion, even in healthy, term infants. Maturation of renal function in
particular of glomerular filtration rate is gestational age and postnatal age-dependant. Moreover, many neonatal pathological conditions
such as preterm birth, sepsis or perinatal asphyxia can also affect renal function. These developmental changes have a major impact on
drug metabolism and elimination. Alterations in renal clearance can influence significantly both drugs efficacy and toxicity. Moreover,
nephrogenesis is a still ongoing process in a number of premature infants before 36 wks postconceptional age. Drugs and toxic factors
that may alter the constitution of the congenital nephron number endowment during this period may have long term consequences on arterial
pressure and renal function at adulthood.
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