Fetal renin-angiotensin-system blockade syndrome: renal lesions.
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.


CONCLUSIONS
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.
CHU de Poitiers Service d'Anatomie et Cytologie Pathologiques, CHU Poitiers, BP 577, 86021, Poitiers, France, carolineplazanet@aol.fr.
Caroline
C
Plazanet
Christelle
C
Arrondel
François
F
Chavant
Marie-Claire
MC
Gubler
D000014:Abnormalities, Drug-Induced; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005315:Fetal Diseases / Q000139:chemically induced*; D006801:Humans; D007150:Immunohistochemistry; D007231:Infant, Newborn; D007668:Kidney / Q000737:chemistry / Q000187:drug effects* / Q000473:pathology; D007684:Kidney Tubules / Q000002:abnormalities*; D012083:Renin / Q000032:analysis
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D012083:Renin