Valsartan fetopathy: a case report

Aims: ACE inhibitors and angiotensin II receptor type 1 antagonists (sartans) are contraindicated during pregnancy due to impaired renal development resulting in tubular dysgenesis. The wide spectrum of manifestations ranges from death as a result of severe complications of renal failure to reversible effects on amniotic fluid after drug withdrawl as well as late preterm and term gestations with only minor problems during neonatal period and favorable outcome concerning renal function.

Case report: At 35 weeks of gestation a 34-year old woman who received valsartan during whole pregnancy for essential hypertension presented with preterm labour and complete anhydramnion. The spontaneously delivered boy showed typical signs of sartan fetotoxicity including neonatal anuria, enlarged hyperechogenic kidneys, arterial hypotension, limb contractures as well as a narrow chest and skull bone hypoplasia. There were no signs of respiratory distress and lung hypoplasia could be excluded by chest X-ray. Volume expansion, dopamine infusion and furosemide administration resulted in a normalization of urine output within 48hrs. Peritoneal dialysis could be avoided. Maximum serum creatinine was 245µmol/l and decreased to age-related normal values within 14 days. On follow-up controls renal function remained stable.

Conclusion: Intake of angiotensin II receptor antagonists during pregnancy results in an interdisciplinary challenge for perinatal medicine. Women who become pregnant need to be changed to a different antihypertensive drug class. Due to an unpredictable course patients need to be treated and followed in neonatal units with adequate pediatric nephrological expertise.

angiotensin II receptor antagonists - anhydramnion - fetopathy - renal failure - valsartan