pituitrin and Ductus-Arteriosus--Patent

Topics: Anti-Inflammatory Agents, Non-Steroidal; Blood Pressure; Ductus Arteriosus, Patent; Endothelin-1; Hemodynamics; Humans; Infant, Newborn; Infant, Premature; Ligation; Vasopressins

When comparing iatrogenic inhibition with endogenous stimulation of renal prostaglandin production, the role of this mediator and modulator system for renal function becomes apparent. Renal perfusion and glomerular filtration as well as modulation of tubular function with respect to electrolyte and water excretion is significantly influenced by renal prostaglandin activity. Treatment with the prostaglandin cyclooxygenase inhibitor indomethacin reduces the endogenous creatinine clearance by about fifty percent in a state of a diminished circulatory blood volume, such as may exist during left-to-right shunting across a persistent ductus arteriosus in preterm infants. In addition, urinary electrolyte and water excretion is reduced by increased tubular absorption leading to marked oliguria. In contrast, electrolytes and water are lost in congenital renal tubular disorders associated with increased prostaglandin E2 (PGE2) activity (a so called hyperprostaglandin E syndrome). Patients with this renal disorder require a permanent high dosed indomethacin therapy. After this pharmacotherapy has brought electrolyte and water metabolism into balance, no deterioration of glomerular filtration and renal perfusion was observed. This is in accordance with the general principle that renal function only becomes dependent on the vasodilatory activity of renal prostaglandins in a stress situation resulting in the threat of hypoperfusion. It is essential to bear in mind the physiological and pathophysiological role of renal prostaglandins, when prescribing frequently administered prostaglandin cyclooxygenase inhibitors like aspirin, paracetamol or indomethacin in pediatrics. Otherwise, renal function may deteriorate or the kidney will be irreversibly damaged.

Topics: Angiotensin II; Aspirin; Child, Preschool; Creatinine; Ductus Arteriosus, Patent; Glomerular Filtration Rate; Humans; Indomethacin; Infant; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Kidney Function Tests; Oliguria; Prostaglandins; Prostaglandins E; Renal Circulation; Renin-Angiotensin System; Vasopressins; Water-Electrolyte Balance

Adverse renal reaction during prolonged indomethacin therapy (1 week) was studied in 15 preterm infants with persistent ductus arteriosus (PDA), which was associated with an ineffective circulatory volume. Following the medication a decrease in diuresis and creatinine clearances together with an increase in urinary osmolality and body weight was observed. Determinations of selected vasoactive hormones, such as plasma renin activity (PRA), antidiuretic hormone (ADH), and renal and systemic prostaglandins, indicated a complex pathophysiological condition of renal hypoperfusion and antidiuretic excess. During the treatment with indomethacin an effective circulatory volume had been restored by closing the ductus, which was followed by hormonal normalization. Subsequently kidney function was recovering despite continued indomethacin therapy. Based on these observations, one may assume that prolonged indomethacin therapy for prevention of PDA relapses is probably of no further harm to kidney function once the ductus has been closed successfully.

Topics: Blood Volume; Body Weight; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Kidney; Kidney Function Tests; Oliguria; Osmolar Concentration; Prostaglandins; Renin; Time Factors; Vasopressins

Topics: Arginine Vasopressin; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Syndrome; Vasopressins

Topics: Adult; Arteriosclerosis; Ductus Arteriosus; Ductus Arteriosus, Patent; Familial Primary Pulmonary Hypertension; Humans; Hypertension; Hypertension, Pulmonary; Lung Diseases; Pathology; Pharmacology; Pulmonary Circulation; Rabbits; Research; Vasopressins