Exposure to furosemide as the strongest risk factor for nephrocalcinosis in preterm infants

Gimpel, Charlotte; Krause, Alexandra; Franck, P.; Krueger, Marcus; Schnakenburg, Christian von

doi:10.1111/j.1442-200x.2009.02886.x

Cited by 62 publications

(58 citation statements)

References 31 publications

(49 reference statements)

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“…But there is a risk of kidney toxicity. Although acute kidney toxicity is not expected or seen, higher dose levels of furosemide are associated with renal calcification in children [9]. Regarding kidney development, the described effects are more controversial.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Early Postnatal Diuretics Treatment on Kidney Development and Long-Term Kidney Function in Wistar Rats

Bueters

Jeronimus-Klaasen²,

Maicas³

et al. 2016

Nephron

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Background: Diuretics are administered to neonates to control fluid balance. We studied whether clinical doses affected kidney development and function and whether extrauterine growth retardation (EUGR) could be a modulator. Methods: Wistar rats were cross-fostered in normal food or food restricted litters at postnatal day (PND) 2 and treated daily with 0.9% NaCl, 5 mg/kg furosemide or 5 mg/kg hydrochlorothiazide (HCTZ) up to PND 8. Kidneys were evaluated on proliferation, apoptosis and a set of mRNA target genes at PND 8, glomerular- and glomerular generation count at PND 35, clinical pathology parameters at 3- and 9 months, neutrophil gelatinase-associated lipocalin at PND 8, 3 and 6 months, monthly blood pressure from 3 months onward and histopathology at study end. Results: Treatment with furosemide or HCTZ did not have relevant effects on measured parameters. EUGR resulted in lower body weight from day 3 onwards (-29% at weaning; p < 0.001, -10% at necropsy; p < 0.001), less glomerular generations (4.4 ± 0.32 vs. 5.0 ± 0.423; p = 0.025, males only), decreased glomerular numbers (27,861 ± 3,468 vs. 30,527 ± 4,096; p = 0.026), higher creatinine clearance (0.84 ± 0.1 vs. 0.77 ± 0.09 ml/min/kg; p = 0.047) at 3 months and lower plasma creatinine (25.7 ± 1.8 vs. 27.5 ± 2.8 µmol/l; p = 0.043) at 9 months. Conclusion: Furosemide and HCTZ did not influence kidney development or function when administered in a clinically relevant dose to rat pups at a stage of ongoing nephrogenesis. EUGR led to impaired kidney development but did not modify furosemide or HCTZ findings.

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Section: Introductionmentioning

confidence: 99%

The Effects of Early Postnatal Diuretics Treatment on Kidney Development and Long-Term Kidney Function in Wistar Rats

Bueters

Jeronimus-Klaasen²,

Maicas³

et al. 2016

Nephron

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“…[3][4][5][6][7][8][9] The varying prevalence of NC is considered to be due different study populations and era, development in the sensitivity of ultrasound equipment, and workmanship of the observer. 27 In several reports, the incidence of NC showed a decreasing trend with development in care of preterm infants, 6,20,24 but this study showed an increasing tendency for NC.…”

Section: Discussionmentioning

confidence: 99%

“…Among different studies, the prevalence of NC ranged from 7 to 41% in very low birth weight (VLBW) infants with a gestational age less than 32 weeks. [3][4][5][6][7][8][9] The etiology of NC is multifactorial including low gestational age and birth weight. Male sex, family history, white race, mechanical ventilation, oxygen therapy, bronchopulmonary dysplasia (BPD), the use of furosemide, methylxanthine, dexamethasone, gentamicin, total parenteral nutrition (TPN), acidosis, hypercalcemia, hypophosphatemia, hypercalciuria, hyperoxaluria, hyperuricuria, and hypocitruria are associated with development of NC.…”

mentioning

confidence: 99%

Risk Factors and Outcome of Nephrocalcinosis in Very Low Birth Weight Infants

et al. 2015

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� Original Article � furosemide therapy in 1982. Among different studies, the prevalence of NC ranged from 7 to 41% in very low birth weight (VLBW) infants with a gestational age less than 32 weeks. [3][4][5][6][7][8][9] The etiology of NC is multifactorial including low gestational age and birth weight. Male sex, family history, white race, mechanical ventilation, oxygen therapy, bronchopulmonary dysplasia (BPD), the use of furosemide, methylxanthine, dexamethasone, gentamicin, total parenteral nutrition (TPN), acidosis, hypercalcemia, hypophosphatemia, hypercalciuria, hyperoxaluria, hyperuricuria, and hypocitruria are associated with development of NC. Purpose: The aim of this study was to determine the incidence, risk factors, and long-term outcome of nephrocalcinosis in very low birth weight (VLBW) infants. Methods: A retrospective chart review was performed in VLBW infants between 2006 and 2012 in the neonatal intensive care unit. Results:The incidence of nephrocalcinosis in VLBW infants was 10.2%. By univariate analysis, oligohydramnios and use of antenatal steroids were more frequent in the nephrocalcinosis group. In the nephrocalcinosis group, the gestational age and birth weight were lower and there were more number of female infants. Also, the initial blood pH, the lowest systolic blood pressure, and urine output on the first day of life were lower and bronchopulmonary dysplasia, sepsis, and urinary tract infection were more prevalent in the nephrocalcinosis group. The use of dexamethasone or ibuprofen and the lowest levels of phosphorus, protein and albumin were significantly lower in the nephrocalcinosis group. By binary logistic regression analysis, the use of antenatal steroids, female sex, 5-minute Apgar score, duration of oxygen therapy and total parenteral nutrition, and the lowest albumin level were found to be significant risk factors for nephrocalcinosis. Overall, the resolution rate was 64.1% and 88.6% within 12 months and 18 months, respectively. Conclusions:The incidence of nephrocalcinosis in VLBW infants showed increasing trend. The risk factors of nephrocalcinosis were parameters for sick VLBW infants. Although the prognosis of nephrocalcinosis was relatively good, we should pay close attention to the development of complication.

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“…The prevalence is strongly associated with lower birth weight and total daily dose of diuretic, and severe cases of calcium deposits requiring intervention have been reported (90).…”

Section: S41mentioning

confidence: 99%

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

McCammond

Axelrod

Bailly

et al. 2016

Pediatric Critical Care Medicine

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Fluid management is challenging in critically ill pediatric cardiac patients. A myriad of causes may be contributory, including intrinsic myocardial dysfunction with its associated neuroendocrine response, renal dysfunction with oliguria, and systemic inflammation with resulting endothelial dysfunction. The development of fluid overload has been associated with adverse outcomes, including acute kidney injury, prolonged mechanical ventilation, increased vasoactive support, prolonged hospital length of stay, and mortality. An in-depth understanding of the many factors that influence volume status is necessary to guide optimal management.

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Exposure to furosemide as the strongest risk factor for nephrocalcinosis in preterm infants

Abstract: We suggest that in preterm infants, furosemide should be prescribed with caution and close monitoring of calcium excretions is advisable. Some guidelines for infant respiratory distress syndrome now favor calcium-sparing thiazides if diuretics are considered.

Cited by 62 publications

References 31 publications

The Effects of Early Postnatal Diuretics Treatment on Kidney Development and Long-Term Kidney Function in Wistar Rats

The Effects of Early Postnatal Diuretics Treatment on Kidney Development and Long-Term Kidney Function in Wistar Rats

Risk Factors and Outcome of Nephrocalcinosis in Very Low Birth Weight Infants

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

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