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Drug combination induced AKI
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Drug combination induced AKI
in NICU
- prevalence of AKI
Introduction
Recent studies evaluating the epidemiology of AKI have shown that it is common in the neonatal intensive care unit (NICU) with incidence varying between 18–70%
WHAT is AKI
in Neonates ?
AKI definition
in Neonates
increase in serum creatinine 0.3 mg/dL or 1.5 times the baseline creatinine, which was considered to be the most recent serum creatinine value within 2 days of first drug combination exposure.
- Risk factors of Neonatal AKI incidence:
• Critically ill neonatal
• congenital heart diseases
• perinatal asphyxia
• sepsis
• premature birth
Risk factors
Outcomes of Neonatal AKI
- outcomes of Neonatal AKI
- Associated with higher mortality and longer hospital stays compared with infants without AKI after adjusting for known risk factors.
- The mortality rate in infants with AKI is 9.7% compared to 1.4% in infants without AKI.
Drug induced AKI
Nephrotoxic medication taken during fetal life or during postnatal nephrogenesis could interfere with nephron generation, contributing to a peculiar magnitude of damage. Such adjunctive damage could further increase the risk of CKD in children born prematurely.
Aminoglycosides
Aminoglycosides
- greater in preterms infants
- action of aminoglycosides on glomerular and renal tubular function
- urinary a1-microglobulin excretion (marker of renal tubular dysfunction), was significantly higher in those who had been treated with aminoglycosides
NSAIDs
NSAIDs
lead to hypoperfusion of the kidneys and long-term renal dysfunction.
lead to cystic changes in the developing nephrons, and to acute renal failure in newborns.
ACE inhibitors
ACE
inhibitors
Human fetopathies such as oligohydramnios, renal tubular dysgenesis, and neonatal anuria were observed when these drugs were given after the first trimester of pregnancy, the period of fetal kidney development.
9% of newborns had major congenital anomalies (cardiovascular, central nervous system, and renal malformations)
Antifungals
Antifungals
Renal damage from amphotericin B deoxycholate found in 44% of low birth weight infants.
The most frequent complications from amphotericin B were tubulotoxicity,
renal tubular acidosis, and
loss of urinary concentrating ability.
Prevention
-prevention
1- Administering combinations of nephrotoxic drugs for the shortest time possible.
2- switching to a less nephrotoxic alternative agent.
3- identify high-risk infants.
4- Don’t increase interval of antibiotic.
5- Don’t increase time of infusion (you don’t reach a peak of drug).
TIMELINE
Results
• chlorothiazide + indomethacin combination was associated with an increased risk of AKI relative to gentamicin + indomethacin
• Furosemide + tobramycin and vancomycin + piperacillin were associated with a decreased risk of AKI relative to gentamicin + indomethacin
Conclusion
Conclusion
"
1- The duration of combination therapy was associated with an increased risk of AKI
2- Avoiding NTM during fetal life and perinatal period to avoid renal injury.
"
Organization team
1. Doha Mohsen
2. Burhansyah Azhar
3. Mohamed Abdelaziz
4. Shymaa Abdelaziz
5. Asmaa Bendary
6. Yosuf Marzouk
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