Role of Methylxanthines in Preventing Acute Renal Failure in Hypoxic Newborns

Abstract

Abstract Background Acute renal failure secondary to perinatal asphyxia is a serious & common problem in developing countries due to lack of appropriate delivery facilities. Under hypoxic conditions, there is an excess of adenosine production, which by its virtue of renal vasoconstriction serves to reduce the glomerular filtration rate. Studies have reported beneficial role of adenosine blockade by methylxanthines in preventing acute oliguric renal failure in hypoxic neonates. Methods We reviewed the available literature on pathophysiology of acute renal failure in hypoxic newborns and the therapeutic usefulness of methylxanthines in managing such patients. Well-designed randomized controlled trials evaluating the efficacy of methylxanthines in preventing acute oliguric renal failure were specifically reviewed for the methodology and outcome. Results Methylxanthines when used in hypoxic neonates seem to prevent oliguric renal failure. Their use has been associated with increased natriuresis and diuresis in initial hours of life in at risk patients and better outcome. Drug related side effects may be prevented by careful patient selection and drug level monitoring.