Neonatal renal physiology

The renal system plays a tremendous role in growth and development of infants and children. The kidney itself also undergoes a maturation process as it transitions from the fetal to the extrauterine environment. Renal function continues to undergo further adaptive changes in the neonatal period. It is important for the clinician caring for neonates to be aware of the expected fluid shifts, electrolyte handling, and renal functional capacity as these “normal” changes will become quite relevant when medical or surgical pathology is present. The preterm neonates are especially vulnerable due to their functionally immature kidneys. Renal function in the preterm neonate is not only immature at birth but there is a significant delay in the renal function to achieve its full capacity. This review highlights the physiologic adaptations of the kidney and its effects on the body during the neonatal period.