新生儿药物性急性肾损伤
Drug-induced acute kidney injury in neonates.
作者信息
Hanna Mina H, Askenazi David J, Selewski David T
机构信息
aDivision of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky bDivision of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama cDivision of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
Curr Opin Pediatr. 2016 Apr;28(2):180-7. doi: 10.1097/MOP.0000000000000311.
PURPOSE OF REVIEW
Acute kidney injury (AKI) is an independent risk factor for morbidity and mortality in critically ill neonates. Nephrotoxic medication exposure is common in neonates. Nephrotoxicity represents the most potentially avoidable cause of AKI in this population.
RECENT FINDINGS
Recent studies in critically ill children revealed the importance of recognizing AKI and potentially modifiable risk factors for the development of AKI such as nephrotoxic medication exposures. Data from critically ill children who have AKI suggest that survivors are at risk for the development of chronic kidney disease. Premature infants are born with incomplete nephrogenesis and are at risk for chronic kidney disease. The use of nephrotoxic medications in the neonatal intensive care unit is very common; yet the effects of medication nephrotoxicity on the short and long-term outcomes remains highly understudied.
SUMMARY
The neonatal kidney is predisposed to nephrotoxic AKI. Our ability to improve outcomes for this vulnerable group depends on a heightened awareness of this issue. It is important for clinicians to develop methods to minimize and prevent nephrotoxic AKI in neonates through a multidisciplinary approach aiming at earlier recognition and close monitoring of nephrotoxin-induced AKI.
综述目的
急性肾损伤（AKI）是危重新生儿发病和死亡的独立危险因素。新生儿接触肾毒性药物很常见。肾毒性是该人群中AKI最有可能避免的病因。
最新发现
近期对危重症儿童的研究揭示了认识AKI以及AKI发生发展的潜在可改变危险因素（如肾毒性药物暴露）的重要性。AKI危重症儿童的数据表明，幸存者有患慢性肾脏病的风险。早产儿出生时肾发育不全，有患慢性肾脏病的风险。新生儿重症监护病房中使用肾毒性药物非常普遍；然而，药物肾毒性对短期和长期预后的影响仍未得到充分研究。
总结
新生儿肾脏易发生肾毒性AKI。我们改善这一弱势群体预后的能力取决于对该问题的高度认识。临床医生通过多学科方法，旨在更早识别和密切监测肾毒素诱发的AKI，制定方法以尽量减少和预防新生儿肾毒性AKI非常重要。
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