Perinatology.  2021 Mar;32(1):48-53. 10.14734/PN.2021.32.1.48.

Angiotensin II Receptor Blocker Fetopathy with Persistent Pulmonary Hypertension, Hypocalvaria, Nephrogenic Diabetes Insi pidus, Transient Pseudohypoaldosteronism and Polycythemia

Affiliations
  • 1Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 2Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea

Abstract

Renin-angiotensin system (RAS) has a significant role in the regulation of blood pressure. The use of RAS blocker (angiotensin converting enzyme inhibitor or angiotensin II receptor blocker [ARB]) for hypertension is common, but this medication during pregnancy may lead to dysgenesis of renal tubule, hypoperfusion and hypoplastic growth of skull and pulmonary vascular hypoplasia in fetus. We report a female baby born to a mother who took ARB up to gestational age 35 weeks, and then did not take ARB for 10 days until delivery on IUP 36 +3 weeks. The baby suffered from hypotension and anuria for few days but suffered severe respiratory difficulty and pulmonary hypertension requiring mechanical ventilation with inhalation of nitric oxide. The baby had also limb contracture, defects of skull ossification, and thrombocytosis. After weaning of mechanical ventilation, the baby had a polyuria and was diagnosed with transient partial nephrogenic diabetes insipidus. The baby showed polycythemia with normal kidney function at 20 months of age. The baby showed normal growth and development based on the results of the Korean Development Screening Test with 20 months of corrected ages.

Keyword

Angiotensin receptor antagonist; Diabetes insipidus; Nephrogenic; Maternal exposure; Persistent fetal circulation; Cranial sutures
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