Salt-losing nephrogenic diabetes insipidus caused by fetal exposure to angiotensin receptor blocker
Salt-losing nephrogenic diabetes insipidus caused by fetal exposure to angiotensin receptor blocker
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DOI：
10.1007/s00467-008-1091-8
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发表时间：
2009-06-01
影响因子：
3
通讯作者：
Igarashi, Takashi
中科院分区：
文献类型：
--
作者：
Miura, Kenichiro;Sekine, Takashi;Igarashi, Takashi
据报道，孕妇使用血管紧张素转换酶抑制剂（ACEIs）或血管紧张素1型受体阻滞剂（ARB）可引起ACEI/ARB胎儿病，包括羊水过少、肺发育不全、肾功能不全、肢体挛缩和胎儿低血压。大多数患者在新生儿期死亡或发展为终末期肾衰竭。ARB胎儿病患者肾功能不全的长期预后尚未报道。我们报告两个儿科病例，一个6岁和2岁的男孩，分别与ARB胎儿病的肾功能进行了彻底评估后，从新生儿肾功能衰竭恢复。两例患者均表现为（1）肾小球滤过率轻度降低，（2）无明显近端肾小管功能障碍，（3）盐丢失性肾源性尿崩症，而精氨酸加压素排泄和尿cAMP水平升高。这2例患者的数据表明，ARB对胎仔给药严重损害了尿液浓缩能力，可能是由于乳头状萎缩和髓质中渗透梯度形成紊乱所致，这已在ACEI或ARB给药的新生大鼠中得到证实。不得对孕妇使用ACEI/ARB。
The administration of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin type 1 receptor blockers (ARBs) to pregnant women has been reported to cause ACEI/ARB fetopathy, including oligohydramios, pulmonary hypoplasia, renal insufficiency, limb contracture, and fetal hypotension in the child. Most of the patients die or develop end-stage renal failure during the neonatal period. The long-term prognosis of renal dysfunctions of patients with ARB fetopathy has not been reported. We report two pediatric cases, a 6- and 2-year-old boy, respectively, with ARB fetopathy whose renal functions were thoroughly evaluated after recovery from neonatal renal failure. Both patients showed (1) mildly decreased glomerular filtration rate, (2) no significant proximal tubular dysfunctions, and (3) salt-losing nephrogenic diabetes insipidus, while the excretion of arginine vasopressin and urine level of cyclic AMP were increased. The data on these two patients indicate that the administration of ARB to the fetus profoundly impairs the urine concentrating ability, probably due to papillary atrophy and the disturbed formation of the osmotic gradient in the medulla, which have been confirmed in neonatal rats administered with ACEIs or ARBs. ACEIs/ARBs must not be administered to pregnant women.