Seyberth H W, Rascher W, Hackenthal R, Wille L
J Pediatr. 1983 Dec;103(6):979-84. doi: 10.1016/s0022-3476(83)80736-7.
Renal function and changes in the activity of selected vasoactive hormones during prolonged indomethacin therapy (1 week) were studied in 11 very-low-birth-weight infants with symptomatic patent ductus arteriosus. The initiation of indomethacin therapy was associated with a reduction in diuresis, a transient decrease in creatinine clearance, and an increase in body weight (P less than 0.01). Furthermore, there was a transient trend toward hyponatremia and hyperkalemia. This acute renal dysfunction was compatible with a complex picture of renal hypoperfusion associated with a fall of plasma renin activity from high levels prior to indomethacin treatment, with a transient rise in the plasma level of arginine vasopressin and with suppressed renal and systemic prostaglandin synthesis. During treatment, an effective circulatory volume was restored by closing the ductus. In parallel, PRA and AVP plasma concentrations returned to nearly normal values. Subsequently, kidney function was not further impaired despite continued indomethacin therapy. These observations suggest that prolonged indomethacin therapy for prevention of sPDA relapse probably constitutes no further risk to kidney function after successful pharmacologically induced ductal constriction.
对11例有症状的动脉导管未闭极低出生体重儿进行了研究，观察了长期（1周）吲哚美辛治疗期间的肾功能及某些血管活性激素活性的变化。吲哚美辛治疗开始时，尿量减少，肌酐清除率短暂下降，体重增加（P<0.01）。此外，有短暂的低钠血症和高钾血症趋势。这种急性肾功能障碍与肾灌注不足的复杂情况相符，与吲哚美辛治疗前血浆肾素活性从高水平下降、精氨酸加压素血浆水平短暂升高以及肾和全身前列腺素合成受抑制有关。治疗期间，通过关闭动脉导管恢复了有效循环血量。同时，血浆肾素活性（PRA）和精氨酸加压素（AVP）浓度恢复到接近正常水平。随后，尽管继续使用吲哚美辛治疗，肾功能未进一步受损。这些观察结果表明，在成功进行药物诱导的导管收缩后，长期使用吲哚美辛预防动脉导管未闭复发可能不会对肾功能构成进一步风险。
