Child Kidney Dis.
2023 Dec;27(2):121-126. 10.3339/ckd.23.022.
Angiotensin receptor blocker induced fetopathy: two case reports and literature review
- Affiliations
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- 1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- KMID: 2549744
- DOI: http://doi.org/10.3339/ckd.23.022
Abstract
- The administration of angiotensin type 2 receptor blockers (ARBs) during pregnancy is known to cause ARB fetopathy, including renal insufficiency. We aimed to analyze the outcomes of two patients who survived ARB fetopathy and perform an accompanying literature review. Case 1 was exposed antenatally from a gestational age of 30 weeks to valsartan because of maternal pregnancy-induced hypertension. The patient presented with oliguria immediately after birth, and renal replacement therapy was administered for 24 days. Seven years after birth, renal function was indicative of stage 2 chronic kidney disease (CKD) with impaired urinary concentration. Case 2 had a maternal history of hypertension and transient ischemic attack and was treated with olmesartan until 30 weeks of pregnancy. Renal replacement therapy was performed for 4 days since birth. After 8 years, the patient is with CKD stage 2, with intact tubular function. Recent reports suggest that ARB fetopathy might manifest as renal tubular dysgenesis and nephrogenic diabetes insipidus, in contrast to mild alterations of glomerular filtration. Tubular dysfunction may induce CKD progression and growth retardation. Patients with ARB fetopathy should be monitored until adulthood. The ARB exposure period might be a critical factor in determining the severity and manifestations of fetopathy.
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Figure
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Fig. 1. (A) Case 1 was administered PD for anuric AKI on the 2nd day of hospitalization. Renal replacement therapy, including CRRT, was continued for 24 days. The patient was discharged on hospital day of 38. (B) Case 2 was initiated CRRT for anuric AKI on the first day of hospitalization. CRRT was administered for 4 days. The patient was discharged on hospital day of 31. Cr, creatinine; PD, peritoneal dialysis; CRRT, continuous renal replacement therapy; AKI, acute kidney injury.