Renal failure and persistent hypertension in a child prenatally exposed to losartan

Abstract

Objective – To underline the fetal kidney toxicity of losartan, an angiotensin receptor blocker (ARB), administered to a woman during pregnancy.

Case report – We describe a male infant, prenatally exposed to losartan from week 32 of gestation, born at term by cesarean section due to maternal hypertension and oligohydramnios. The baby was admitted to the NICU of our hospital for anuria; he required peritoneal dialysis and survived the neonatal period. Presently, the child is 24 months old and is affected by severe chronic renal failure, failure to thrive and persistent hypertension.

Conclusions – Although ARBs are recommended as first line antihypertensive agents, their administration should be avoided during pregnancy, especially from the second trimester onward. Most fetuses, affected by ARB toxicity, progress to death. The few that survive show serious outcomes. If a pregnant woman is under antihypertensive treatment with ARB, this has to be discontinued and replaced as soon as possible, and especially within the second trimester of pregnancy. Obstetricians should also be alerted of the potential risks of ARB administration beyond the first trimester of gestation.