Prophylactic theophylline to prevent renal dysfunction in newborns exposed to perinatal asphyxia—a study in a developing country

Bakr, Ahmad Fayez

doi:10.1007/s00467-005-1980-z

Cited by 81 publications

(67 citation statements)

References 23 publications

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“…Several independent randomized studies in asphyxiated infants have shown that prophylactic theophylline, given early after birth, was associated with better kidney function. [70][71][72][73] As a result, the KDIGO guidelines recommend a single dose of theophylline for asphyxiated infants at risk for AKI. 44 Caution must be taken, as theophylline has some potentially harmful neurologic effects.…”

Section: Neonatal Cardiac Surgerymentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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Section: Neonatal Cardiac Surgerymentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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“…Furthermore, acute theophylline treatment given at 5 days after ischemia acutely increases renal blood flow and GFR in previously untreated rats, indicating that adenosine contributes to the suppression of renal blood flow and GFR in the maintenance phase of ischemic reperfusion injury (199). With regard to studies in humans, a single dose of theophylline, given early after birth, has beneficial effects in reducing the renal involvement and fall in GFR in asphyxiated full-term infants as determined over the first 5 days (14). In contrast, pretreating rats before renal artery occlusion for 30 min with dipyridamole, which increases extracellular adenosine concentrations, intensified the fall in renal blood flow and GFR determined ϳ1 h after releasing the clamp, and this impairment was blocked by theophylline (198).…”

Section: B Ischemia-reperfusion Injurymentioning

confidence: 99%

Adenosine and Kidney Function

Vallon

Mühlbauer²,

Oßwald³

2006

Physiological Reviews

395

379

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In this review we outline the unique effects of the autacoid adenosine in the kidney. Adenosine is present in the cytosol of renal cells and in the extracellular space of normoxic kidneys. Extracellular adenosine can derive from cellular adenosine release or extracellular breakdown of ATP, AMP, or cAMP. It is generated at enhanced rates when tubular NaCl reabsorption and thus transport work increase or when hypoxia is induced. Extracellular adenosine acts on adenosine receptor subtypes in the cell membranes to affect vascular and tubular functions. Adenosine lowers glomerular filtration rate (GFR) by constricting afferent arterioles, especially in superficial nephrons, and acts as a mediator of the tubuloglomerular feedback, i.e., a mechanism that coordinates GFR and tubular transport. In contrast, it leads to vasodilation in deep cortex and medulla. Moreover, adenosine tonically inhibits the renal release of renin and stimulates NaCl transport in the cortical proximal tubule but inhibits it in medullary segments including the medullary thick ascending limb. These differential effects of adenosine are subsequently analyzed in a more integrative way in the context of intrarenal metabolic regulation of kidney function, and potential pathophysiological consequences are outlined.

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“…However, clinical trials are lacking in children for most of these medications. Several studies in neonates with perinatal asphyxia have suggested that a single dose of theophylline early after birth resulted in improved renal function and urine output [116][117][118]. Owing to the availability of standardized AKI definitions, the presence of renal tissue injury biomarkers, and the recent international recognition of AKI as an important condition to treat, several clinical trials (clinicaltrials.gov) are currently under way (some of these described in Table 7) and will hopefully lead to specific medical treatment or prevention of AKI in future years.…”

Section: Pharmacological Therapymentioning

confidence: 99%