title: Angiotensin II receptor blocker induced fetopathy: 7 cases.
abstract: BACKGROUND
  During a period of 12 months 7 newborns with a partially severe fetopathy caused most probably by maternal sartan-intake in pregnancy were treated in 5 German teaching hospitals. Sartans antagonize the effect of angiotensin II at the AT1-receptor and are used to treat arterial hypertension.
  
  
  METHODS
  We presented 2 cases at the yearly GNPI meeting 2010 and we were informed about similar cases in other German teaching hospitals which we brought together in this publication.
  
  
  RESULTS
  In the presented cases, maternal sartan intake was noticed at different times in pregnancy and was in part discontinued some weeks before delivery. In all pregnancies oligohydramnios was present and fetal kidneys displayed a hyperechogenic structure on ultrasound. The newborns' postnatal course varied: oligohydramnios sequence with lung hypoplasia, arterial hypotension and renal insufficiency were the predominant problems of the first days of life. The majority (4/7) of infants did not survive this period, in other cases there was a complete (1/7) recovery of renal function whereas others survived with renal impairment (2/7), in part requiring chronic dialysis. Further distinctive features seen frequently were disturbances of cranial ossification and flaccid paralysis of hands and feet with deviations as well as sensorineural hearing loss.
  
  
  CONCLUSIONS
  These case reports again underline the hazardousness of maternal sartan intake with potential fatal outcome for the newborn. Though the use of sartans in pregnancy is contraindicated and several case reports of sartan induced fetopathies exist, the risk of sartan treatment generally seems to be underestimated.
authors.affiliation: Neonatology, Children's Hospital, University of Cologne, Germany. christoph.huenseler@uni-koeln.de
authors.forename: C
authors.initials: C
authors.lastname: Hünseler
authors.forename: A
authors.initials: A
authors.lastname: Paneitz
authors.forename: D
authors.initials: D
authors.lastname: Friedrich
authors.forename: U
authors.initials: U
authors.lastname: Lindner
authors.forename: A
authors.initials: A
authors.lastname: Oberthuer
authors.forename: F
authors.initials: F
authors.lastname: Körber
authors.forename: K
authors.initials: K
authors.lastname: Schmitt
authors.forename: L
authors.initials: L
authors.lastname: Welzing
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.forename: P
authors.initials: P
authors.lastname: Herkenrath
authors.forename: B
authors.initials: B
authors.lastname: Hoppe
authors.forename: L
authors.initials: L
authors.lastname: Gortner
authors.forename: B
authors.initials: B
authors.lastname: Roth
authors.forename: E
authors.initials: E
authors.lastname: Kattner
authors.forename: T
authors.initials: T
authors.lastname: Schaible
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use / Q000633:toxicity*; D000959:Antihypertensive Agents / Q000627:therapeutic use / Q000633:toxicity*; D001034:Apgar Score; D001562:Benzimidazoles / Q000627:therapeutic use / Q000633:toxicity; D001713:Biphenyl Compounds; D005260:Female; D005317:Fetal Growth Retardation / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy*; D006976:Hypertension, Pulmonary / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D007093:Imidazoles / Q000627:therapeutic use / Q000633:toxicity; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities / Q000187:drug effects / Q000473:pathology; D008168:Lung / Q000002:abnormalities / Q000187:drug effects / Q000473:pathology; D008297:Male; D016104:Oligohydramnios / Q000139:chemically induced; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D051437:Renal Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D012886:Skull / Q000002:abnormalities / Q000187:drug effects / Q000473:pathology; D013777:Tetrazoles / Q000627:therapeutic use / Q000633:toxicity; D016216:Ultrasonography, Prenatal; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use / Q000633:toxicity; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D007093:Imidazoles; D013777:Tetrazoles; D000068756:Valsartan; C437965:olmesartan; D014633:Valine; C081643:candesartan