title: Renin Angiotensin System Blocker Fetopathy: A Midwest Pediatric Nephrology Consortium Report.
abstract: OBJECTIVE
  Fetuses continue to be exposed to renin angiotensin system (RAS) blockers despite their known teratogenicity and a black box warning. We hypothesized that fetopathy from in utero exposure to RAS blockers has a broader spectrum of clinical manifestations than described previously and that there are a variety of clinical scenarios leading to such exposures.
  
  
  METHODS
  This was a retrospective study performed through the Midwest Pediatric Nephrology Consortium. Cases of RAS blocker fetopathy were identified, with determination of renal and extrarenal manifestations, timing of exposure, and the explanation for the fetal exposure.
  
  
  RESULTS
  Twenty-four cases were identified. RAS blocker exposure after the first trimester was associated with more severe renal manifestations. Chronic dialysis or kidney transplantation was required in 8 of 17 (47%) patients with RAS blocker exposure after the first trimester and 0 of 7 patients with exposure restricted to the first trimester (P = .05). Extrarenal manifestations, some not previously noted in the literature, included central nervous system anomalies (cystic encephalomalacia, cortical blindness, sensorineural hearing loss, arachnoid cysts) and pulmonary complications (pneumothorax, pneumomediastinum). RAS blocker exposure usually was secondary to absent or poor prenatal care or undiagnosed pregnancy.
  
  
  CONCLUSIONS
  RAS blocker fetopathy continues to be a cause of considerable morbidity, with more severe renal manifestations associated with exposure after the first trimester. A variety of significant extrarenal manifestations occur in these patients. Clinicians should emphasize the risk of fetopathy when prescribing RAS blockers to women of childbearing age.
authors.affiliation: Louisiana State University Health Sciences Center, Shreveport, LA. Electronic address: snadee@lsuhsc.edu.
authors.forename: Shahid
authors.initials: S
authors.lastname: Nadeem
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Shireen
authors.initials: S
authors.lastname: Hashmat
authors.affiliation: University of Miami/Holtz Children's Hospital, Miami, FL.
authors.forename: Marissa J
authors.initials: MJ
authors.lastname: Defreitas
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Westreich
authors.affiliation: Sidra Medical and Research Center, Doha, Qatar.
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Shatat
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: David T
authors.initials: DT
authors.lastname: Selewski
authors.affiliation: West Virginia University, Morgantown, WV.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Onder
authors.affiliation: West Virginia University, Charleston, WV.
authors.forename: Myra
authors.initials: M
authors.lastname: Chiang
authors.affiliation: Levine Children's Hospital, Charlotte, NC.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Weaver
authors.affiliation: Helen DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: Julia
authors.initials: J
authors.lastname: Steinke
authors.affiliation: University of Virginia, Charlottesville, VA.
authors.forename: John
authors.initials: J
authors.lastname: Barcia
authors.affiliation: Seattle Children's Hospital, Seattle, WA.
authors.forename: Joel
authors.initials: J
authors.lastname: Hernandez
authors.affiliation: East Carolina University, Greenville, NC.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Hidalgo
authors.affiliation: Nationwide Children's Hospital, Columbus, OH.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Ingraham
authors.affiliation: University of Miami/Holtz Children's Hospital, Miami, FL.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Abitbol
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pan
authors.affiliation: Emory University, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Greenbaum
mesh_terms: D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005333:Fetus / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation; D008297:Male; D018811:Maternal Exposure; D015146:Midwestern United States; D009398:Nephrology / Q000379:methods*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D006435:Renal Dialysis; D012084:Renin-Angiotensin System; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors