Tugay Sevinç, Bircan Zelal, Cağlayan Ciğdem, Arisoy Ayşe Engin, Gökalp Ayşe Sevim
Division of Pediatric Nephrology, Department of Pediatrics, Kocaeli University Hospital, 41380 Kocaeli, Turkey.
Pediatr Nephrol. 2006 Oct;21(10):1389-92. doi: 10.1007/s00467-006-0131-5. Epub 2006 Aug 1.
It has been reported that gentamicin causes natriuresis, magnesuria and calciuria in neonates. The aim of this study was to determine the acute effects of trough and peak levels of gentamicin on the values of serum creatinine (SCr), urine albumin/urine creatinine (UA/UCr), fractional excretion of sodium and potassium (FENa, FEK) and urine calcium/urine creatinine (UCa/UCr) in preterm neonates treated with gentamicin for suspected infection. Baseline levels of serum and urine Cr, Na and K and urine albumin and Ca levels together with trough and peak gentamicin levels were measured in 61 preterm neonates at the start of the therapy, on the day of the third gentamicin dose and 48-72 h after the cessation of the gentamicin therapy. Therapeutic trough and peak levels were recorded in 56 (91.8%) and 39 (63.9%) of the preterm neonates, respectively, whereas high trough (>2 mg/dl) and peak (>9.99 mg/dl) levels were recorded in five (8.1%) and 11 (18%) of the 61 preterm neonates, respectively. Trough and peak levels of gentamicin were positively correlated with SCr, UA/UCr, FENa, FEK and UCa/UCr values. The UA/UCr, FENa and UCa/UCr values recorded during treatment were statistically significantly different from sub-therapeutic, therapeutic and high peak gentamicin levels. Gentamicin was found to have a serum peak level-dependent microalbuminuric, natriuric and calciuric effect in preterm neonates. Based on these results, we suggest that when the monitoring of serum gentamicin levels is not possible, the monitoring of UA/UCr, FENa and UCa/UCr can be useful as a noninvasive alternative.
据报道，庆大霉素可导致新生儿出现利钠、利镁和利钙作用。本研究的目的是确定在因疑似感染接受庆大霉素治疗的早产儿中，庆大霉素谷值和峰值水平对血清肌酐（SCr）、尿白蛋白/尿肌酐（UA/UCr）、钠和钾的分数排泄（FENa、FEK）以及尿钙/尿肌酐（UCa/UCr）值的急性影响。在61例早产儿治疗开始时、第三次庆大霉素给药当天以及庆大霉素治疗停止后48 - 72小时，测量血清和尿液中Cr、Na和K的基线水平以及尿白蛋白和Ca水平，同时测量庆大霉素谷值和峰值水平。分别在56例（91.8%）和39例（63.9%）早产儿中记录到了治疗性谷值和峰值水平，而在61例早产儿中，分别有5例（8.1%）和11例（18%）记录到了高谷值（>2mg/dl）和高峰值（>9.99mg/dl）水平。庆大霉素的谷值和峰值水平与SCr、UA/UCr、FENa、FEK和UCa/UCr值呈正相关。治疗期间记录的UA/UCr、FENa和UCa/UCr值与亚治疗、治疗和高峰值庆大霉素水平在统计学上有显著差异。研究发现，庆大霉素对早产儿具有血清峰值水平依赖性的微量白蛋白尿、利钠和利钙作用。基于这些结果，我们建议，当无法监测血清庆大霉素水平时，监测UA/UCr、FENa和UCa/UCr作为一种非侵入性替代方法可能会有用。
