Renin Angiotensin System Blocker Fetopathy: A Midwest Pediatric Nephrology Consortium Report

Shahid Nadeem, Shireen Hashmat, Marissa J. Defreitas, Katherine D. Westreich, Ibrahim F. Shatat, David T. Selewski, Ali M. Onder, Myra Chiang, Donald J. Weaver, Julia Steinke, John Barcia, Joel Hernandez, Guillermo Hidalgo, Susan E. Ingraham, Carolyn Abitbol, Cynthia Pan, Larry A. Greenbaum

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: 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.

STUDY DESIGN: 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.

CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)881-885
Number of pages5
JournalJournal of Pediatrics
Volume167
Issue number4
DOIs
StatePublished - Oct 1 2015

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Nephrology
Renin-Angiotensin System
Pediatrics
First Pregnancy Trimester
Kidney
Drug Labeling
Encephalomalacia
Cortical Blindness
Nervous System Malformations
Arachnoid Cysts
Mediastinal Emphysema
Prenatal Care
Sensorineural Hearing Loss
Pneumothorax
Kidney Transplantation
Dialysis
Fetus
Central Nervous System
Retrospective Studies
Morbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Nadeem, S., Hashmat, S., Defreitas, M. J., Westreich, K. D., Shatat, I. F., Selewski, D. T., ... Greenbaum, L. A. (2015). Renin Angiotensin System Blocker Fetopathy: A Midwest Pediatric Nephrology Consortium Report. Journal of Pediatrics, 167(4), 881-885. https://doi.org/10.1016/j.jpeds.2015.05.045

Renin Angiotensin System Blocker Fetopathy : A Midwest Pediatric Nephrology Consortium Report. / Nadeem, Shahid; Hashmat, Shireen; Defreitas, Marissa J.; Westreich, Katherine D.; Shatat, Ibrahim F.; Selewski, David T.; Onder, Ali M.; Chiang, Myra; Weaver, Donald J.; Steinke, Julia; Barcia, John; Hernandez, Joel; Hidalgo, Guillermo; Ingraham, Susan E.; Abitbol, Carolyn; Pan, Cynthia; Greenbaum, Larry A.

In: Journal of Pediatrics, Vol. 167, No. 4, 01.10.2015, p. 881-885.

Research output: Contribution to journalArticle

Nadeem, S, Hashmat, S, Defreitas, MJ, Westreich, KD, Shatat, IF, Selewski, DT, Onder, AM, Chiang, M, Weaver, DJ, Steinke, J, Barcia, J, Hernandez, J, Hidalgo, G, Ingraham, SE, Abitbol, C, Pan, C & Greenbaum, LA 2015, 'Renin Angiotensin System Blocker Fetopathy: A Midwest Pediatric Nephrology Consortium Report', Journal of Pediatrics, vol. 167, no. 4, pp. 881-885. https://doi.org/10.1016/j.jpeds.2015.05.045
Nadeem S, Hashmat S, Defreitas MJ, Westreich KD, Shatat IF, Selewski DT et al. Renin Angiotensin System Blocker Fetopathy: A Midwest Pediatric Nephrology Consortium Report. Journal of Pediatrics. 2015 Oct 1;167(4):881-885. https://doi.org/10.1016/j.jpeds.2015.05.045
Nadeem, Shahid ; Hashmat, Shireen ; Defreitas, Marissa J. ; Westreich, Katherine D. ; Shatat, Ibrahim F. ; Selewski, David T. ; Onder, Ali M. ; Chiang, Myra ; Weaver, Donald J. ; Steinke, Julia ; Barcia, John ; Hernandez, Joel ; Hidalgo, Guillermo ; Ingraham, Susan E. ; Abitbol, Carolyn ; Pan, Cynthia ; Greenbaum, Larry A. / Renin Angiotensin System Blocker Fetopathy : A Midwest Pediatric Nephrology Consortium Report. In: Journal of Pediatrics. 2015 ; Vol. 167, No. 4. pp. 881-885.
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AU - Nadeem, Shahid

AU - Hashmat, Shireen

AU - Defreitas, Marissa J.

AU - Westreich, Katherine D.

AU - Shatat, Ibrahim F.

AU - Selewski, David T.

AU - Onder, Ali M.

AU - Chiang, Myra

AU - Weaver, Donald J.

AU - Steinke, Julia

AU - Barcia, John

AU - Hernandez, Joel

AU - Hidalgo, Guillermo

AU - Ingraham, Susan E.

AU - Abitbol, Carolyn

AU - Pan, Cynthia

AU - Greenbaum, Larry A.

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N2 - OBJECTIVES: 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.STUDY DESIGN: 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.CONCLUSION: 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.

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