Cuzzolin L, Dal Cerè M, Fanos V
Department of Medicine and Public Health-Pharmacology, University of Verona, Italy.
Drug Saf. 2001 Jan;24(1):9-18. doi: 10.2165/00002018-200124010-00002.
In this review we report data available from the literature on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the development of nephrotoxicity in the fetus, neonates and children. Up to the present day, several cases of severe and sometimes irreversible renal insufficiency have been described in neonates exposed to indomethacin prenatally or in the first days of life for treatment of patent ductus arteriosus (PDA). Until now, very few studies have been carried out on alternative treatments for PDA in preterm infants; ibuprofen has been shown to be as effective as indomethacin in closing the ductus in this patient group without affecting renal function. In children, NSAID-induced renal failure is a rare event and is usually reversible after discontinuation of the drug. However, caution should be taken when NSAIDs are administered to individuals with preexisting renal problems or with other potentially nephrotoxic drugs. In these situations, new approaches such as cyclo-oxygenase-2 selective inhibitors or prostanoid receptor selective antagonists could lead to alternative therapies for use in paediatrics.
在本综述中，我们报告了文献中有关非甾体抗炎药（NSAIDs）的使用以及胎儿、新生儿和儿童肾毒性发生情况的现有数据。时至今日，已有数例产前或出生后数天内接触吲哚美辛以治疗动脉导管未闭（PDA）的新生儿出现严重且有时不可逆的肾功能不全的病例报道。到目前为止，针对早产儿PDA的替代治疗开展的研究很少；布洛芬已被证明在该患者群体中关闭动脉导管方面与吲哚美辛一样有效，且不影响肾功能。在儿童中，NSAID引起的肾衰竭是罕见事件，停药后通常可逆转。然而，当给已有肾脏问题的个体或同时使用其他潜在肾毒性药物的个体使用NSAIDs时应谨慎。在这些情况下，诸如环氧化酶-2选择性抑制剂或前列腺素受体选择性拮抗剂等新方法可能会带来用于儿科的替代疗法。
