Renal effects of antenatally or postnatally administered steroids.

Détails

ID Serval
serval:BIB_B40BAECB0273
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Renal effects of antenatally or postnatally administered steroids.
Périodique
La Pediatria Medica E Chirurgica : Medical and Surgical Pediatrics
Auteur⸱e⸱s
Cattarelli D., Chirico G., Simeoni U.
ISSN
0391-5387 (Print)
ISSN-L
0391-5387
Statut éditorial
Publié
Date de publication
2002
Peer-reviewed
Oui
Volume
24
Numéro
2
Pages
157-162
Langue
anglais
Notes
Publication types: Journal Article ; Review Publication Status: ppublish
Résumé
Steroids administrated antenatally to the mothers improve postnatal outcomes of the newborns with pleiotropic effects. Furthermore steroids have been used in preterm infants to prevent or treat chronic lung disease. Synthetical glucocorticoids readily cross placental barrier and reach significant pharmacologic levels in the fetus: besides their well known pulmonary effects they have a concomitant maturational effect of postnatal renal function in preterm infants both with a direct and indirect effect. Endogenous and exogenous glucocorticoids play a role in the maintenance of glomerular filtration (GFR). The antenatal administration of steroids increases the GFR, in association to the maturation of the tubular function. According to different studies the improvement of renal function, expressed by the increase of GFR, is only partially referable to the increase of MAP and the improvement of the cardiovascular status, while it was imputable to a direct renal effect of the steroids, especially on the renal blood flow, on functional glomerular surface area available for filtration and on the glomerular filtrate of the single cortical nephron. However debate remains about the mechanism through which steroids would act on the renal vascular smooth muscolature. The increase the GFR observed after the antenatal administration of glucocorticoids in premature fetuses is also accompanied by an increase of urinary flow and of fractional excretion of sodium. Glucocorticoids would increase the proximal reabsorption of sodium increasing directly the function and the expression of the sodium transporters and both indirectly and directly increasing the activity of Na-K-ATPase. In extremely low weight antenatal administration of betamethasone or dexamethasone was associated with lower estimated insensible water loss, secondary to a direct maturational effect in the skin epithelial barrier, as well as an increased reabsorption of the fetal lung fluid. Moreover antenatal glucocorticoid administration was associated, at birth, to a significant suppression of plasma renin activity and angiotensin II in comparison to the controls. Despite the wide use of the steroidal therapy in the prevention of the bronchopulmonary dysplasia, only few articles, in literature, analyse the effects of glucocorticoids on postnatal renal function, such as the increase in urinary flow. The authors think that steroids contribute in a meaningful way to the clinical improvement observed in children with BPD through the maturative action on the premature kidney with effect both at glomerular and tubular level.
Mots-clé
Female, Fetus/drug effects, Glucocorticoids/therapeutic use, Humans, Infant, Newborn, Kidney/drug effects, Kidney/embryology, Pregnancy, Prenatal Care
Pubmed
Création de la notice
22/02/2015 10:04
Dernière modification de la notice
20/08/2019 16:22
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