Nephrotoxic Medication Exposure and Acute Kidney Injury in Neonates

Abstract

Nephrotoxic medication use is common in neonates. In older children, the use of nephrotoxic medication is known to be one of the most common causes of acute kidney injury (AKI) and to be associated with increased morbidity. In critically ill neonates, AKI significantly complicates fluid and electrolyte management and may be an important risk factor for mortality. Better understanding of methods to avoid and detect the presence of nephrotoxicity may lead to more intelligent use of these medications, which could ultimately reduce the incidence of AKI and improve outcomes. In this work, we summarize why neonates are predisposed to drug nephrotoxicity, review the mechanisms and clinical picture of the most common nephrotoxic medications used in neonates (aminoglycosides, vancomycin, amphotericin B, acyclovir, nonsteroidal anti-inflammatory drugs, and radiocontrast agents), and discuss the roles of angiotensin-converting enzyme inhibitors and diuretics in nephrotoxicity. We also suggest ways to avoid and reduce the incidence and complications of neonatal nephrotoxicity.