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Fetal renin-angiotensin-system blockade syndrome: renal lesions

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Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Fetuses exposed to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists during the second and/or third trimesters of gestation are at high risk of developing severe complications. They consist in fetal hypotension, and anuria/oligohydramnios leading to Potter sequence, frequently associated with hypocalvaria. Most fetuses die during the pre- or postnatal period, whereas others recover normal or subnormal renal function. However, the secondary occurrence of renal failure or hypertension has been reported in children after apparent complete recovery.

Methods

In this context, we analyzed renal lesions in 14 fetus/neonates who died soon after exposure to renin-angiotensin-system (RAS) blockers. Our objective was to determine the causes for the persistence or the secondary occurrence of renal complications reported in some of the survivors.

Results

As previously described, renal tubular dysgenesis is usually observed. Additional lesions, such as thickening of the muscular wall of arterioles and interlobular arteries, glomerular cysts, and interstitial fibrosis, develop early during fetal life.

Conclusion

We suggest that renal lesions that develop before birth may persist after withdrawal of the causative drugs and normalization of blood and renal perfusion pressure. Their persistence could explain the severe long-term outcome of some of these patients. Long-term study of children exposed to RAS blockers during fetal life is strongly recommended.

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Acknowledgments

We thank pathologists, fetopathologists, and pediatricians whose participation made this study possible by providing us clinical information and pathological material : R Bouvier (Service d’Anatomie Pathologique, Hôpital Mère Enfant, Bron), JB Gouyon (Service de Pédiatrie, CHU Dijon), P Déchelotte (Service d’Anatomie Pathologique, Hôtel-Dieu, Clermont-Ferrand), AL Delezoide (Service de Biologie du Développement, Hôpital Robert Debré, Paris), C Fernandez (Service d’Anatomie Pathologique, CHU de la Timone, Marseille), B Foliguet (Laboratoire de Biologie de la Reproduction et du Développement, Maternité Universitaire Régionale, Nancy). M Gonzales (Service de Génétique et d’Embryologie Médicales, Hôpital Armand Trousseau, Paris), M Joubert (Service d’Anatomie Pathologique, CHU, Nantes). N Laurent (Service d’Anatomie Pathologique, CHU Dijon), A L’Hermine Coulomb (Service d’Anatomie Pathologique, Hôpital Armand Trousseau, Paris), J Martinovic (Hôpital Antoine Béclère, Clamart), M Peuchmaur (Service d’Anatomie Pathologique, Hôpital Robert Debré, Paris), MF Santos- Carvalho, Lisbonne, J Tantau (Service d’Histologie Embryologie, Hôpital Cochin-Saint Vincent de Paul, Paris), G Tessier (Service de Réanimation Pédiatrique, Hôpital Nord, Saint Etienne).

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Authors and Affiliations

  1. CHU de Poitiers Service d’Anatomie et Cytologie Pathologiques, CHU Poitiers, BP 577, 86021, Poitiers, France

    Caroline Plazanet

  2. INSERM U983 Hôpital Necker-Enfants Malades, 75015, Paris, France

    Christelle Arrondel & Marie-Claire Gubler

  3. CHU de Poitiers, Service de Pharmacologie clinique et Vigilances, Centre Régional de PharmacoVigilance et de Renseignement sur les Médicaments, Poitiers, France

    François Chavant

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  1. Caroline Plazanet
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  2. Christelle Arrondel
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  3. François Chavant
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  4. Marie-Claire Gubler
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Correspondence to Caroline Plazanet.

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Plazanet, C., Arrondel, C., Chavant, F. et al. Fetal renin-angiotensin-system blockade syndrome: renal lesions. Pediatr Nephrol 29, 1221–1230 (2014). https://doi.org/10.1007/s00467-013-2749-4

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  • DOI: https://doi.org/10.1007/s00467-013-2749-4

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