Salt-losing nephrogenic diabetes insipidus caused by fetal exposure to angiotensin receptor blocker.
The administration of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin type 1 receptor blockers (ARBs) to pregnant women has been reported to cause ACEI/ARB fetopathy, including oligohydramios, pulmonary hypoplasia, renal insufficiency, limb contracture, and fetal hypotension in the child. Most of the patients die or develop end-stage renal failure during the neonatal period. The long-term prognosis of renal dysfunctions of patients with ARB fetopathy has not been reported. We report two pediatric cases, a 6- and 2-year-old boy, respectively, with ARB fetopathy whose renal functions were thoroughly evaluated after recovery from neonatal renal failure. Both patients showed (1) mildly decreased glomerular filtration rate, (2) no significant proximal tubular dysfunctions, and (3) salt-losing nephrogenic diabetes insipidus, while the excretion of arginine vasopressin and urine level of cyclic AMP were increased. The data on these two patients indicate that the administration of ARB to the fetus profoundly impairs the urine concentrating ability, probably due to papillary atrophy and the disturbed formation of the osmotic gradient in the medulla, which have been confirmed in neonatal rats administered with ACEIs or ARBs. ACEIs/ARBs must not be administered to pregnant women.
Miura
Kenichiro
K
Department of Pediatrics, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
Sekine
Takashi
T
Iida
Atsuko
A
Takahashi
Kazuhiro
K
Igarashi
Takashi
T
D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D001127:Arginine Vasopressin / Q000378:metabolism; D001224:Aspartic Acid / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D000242:Cyclic AMP / Q000652:urine; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced* / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D010530:Peritoneal Dialysis / Q000379:methods; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D051437:Renal Insufficiency / Q000628:therapy; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D014237:Trichlormethiazide / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D049993:Sodium Chloride Symporter Inhibitors; D001127:Arginine Vasopressin; D001224:Aspartic Acid; D000242:Cyclic AMP; D014237:Trichlormethiazide