Perinatal/Neonatal Case Presentation: Neonatal Acute Renal Failure Secondary to Maternal Exposure to Telmisartan, Angiotensin II Receptor Antagonist

Piètrement, Christine; Malot, Lilia; Santerne, B.; Roussel, Bernard; Motté, Jacques; Morville, P

doi:10.1038/sj.jp.7210871

Cited by 35 publications

(19 citation statements)

References 7 publications

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“…Three trials [22,24,29] investigated add-on therapy of ARAs with ACEi and with proteinuria as the primary parameter (n= 19). We also found 12 articles about AEs [31][32][33][34][35][36][37][38][39][40][41][42], eight of which reported embryotoxic effects of ARAs given during [31][32][33][34][35][36][37][38], whereas one other was a pharmacokinetic study without efficacy data [43] .…”

Section: Study Characteristicsmentioning

confidence: 96%

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Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

et al. 2009

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Our purpose was to evaluate the effects of angiotensin II receptor type 1 antagonists (ARAs) in children and adolescents with hypertension or/and several kinds of nephropathies on blood pressure (BP) and proteinuria and to evaluate related safety issues. Data sources were Medline, Embase, The Cochrane Library, BIOSIS Previews, contact with investigators and manufacturers, personal bibliography of the lead author, and manual searches. We selected randomized controlled trials (RCTs), uncontrolled trials, and case series investigating ARAs in children and adolescents, as well as case reports about adverse events and the embryotoxic effects of ARAs in children. In four RCTs with 698 individuals, mean systolic blood pressure (BP) decreased by 10.5 mmHg [95% confidence interval (CI) 9.8-11.2] and mean diastolic BP by 6.4 mmHg (95% CI 5.8-7.0). Proteinuria decreased by 30-64% (range) in two RCTs and four case series. Safety data were comparable with adult safety data. ARAs can be considered effective and safe in lowering BP and proteinuria in the pediatric age group. The correlation between the surrogate parameters BP and proteinuria with clinical endpoints is documented to a large degree. The evidence is based on RCTs and also on lower evidence levels, such as case series. In some conditions, RCTs in children are not feasible. Registers could provide more evidence in the future.

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Section: Study Characteristicsmentioning

confidence: 96%

“…There was no retardation in growth and development. Pietrement et al [36] reported a newborn baby whose mother had been taking telmisartan (40 mg/day) until the 33rd week of gestation. Two days postpartum, the baby had acute renal failure, which normalized on the third day.…”

Section: Aesmentioning

confidence: 98%

Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

et al. 2009

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“…Two neonates had acute renal failure after birth after exposure to either candesartan or telmisartan until delivery. Both patients recovered without sequelae, but long-term follow-up was not reported [19,20].…”

Section: Commentarymentioning

confidence: 70%

Increased renal echogenicity in a preterm neonate: Answer

et al. 2005

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“…Among those literature reports describing the gestational age, substance used, period of medication intake (gestational trimester) and outcome of the single cases, we identified 34 literature reports 7-40 describing pregnant women who took ARBs on and after GW 13. Among these 34 literature reports, single cases were described in 24 literatures reports, [8][9][10][11][12][13][14]16,17,[19][20][21][22][25][26][27][28]31,33,34,[36][37][38][39] two cases (including one set of twins 15 ) in four reports, 15,18,24,32 three cases in one report, 23 four cases in one report, 30 five cases in one report, 29 seven cases in one report, 7 20 cases in one report 35 and 45 cases in one report. 40 Thus, information was obtained from these 34 reports regarding the clinical courses of 116 fetuses whose mothers took ARBs on and after GW 13.…”

Section: Methodsmentioning

confidence: 98%

Outcomes of 83 fetuses exposed to angiotensin receptor blockers during the second or third trimesters: a literature review

et al. 2015

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This literature review was conducted to provide better counsel to pregnant women who erroneously took angiotensin receptor blockers (ARBs) during the second and/or third trimesters regarding infant outcomes. Information was available on 83 fetuses in 34 literature reports, including one that we encountered recently. Fourteen pregnancies were terminated, and six were unknown regarding status of amniotic fluid volume (AFV). Fifty-eight and five fetuses did and did not show oligohydramnios, respectively, after being exposed to ARBs. Of the 58 fetuses that presented with oligohydramnios, 57 were exposed to ARBs at gestational week (GW) ⩾ 20, and 19 exhibited resolution of oligohydramnios 1-6 weeks after cessation of ARBs. The 24 mothers without oligohydramnios at delivery ceased taking ARBs earlier (GW of 26.8 ± 5.1 vs. 31.8 ± 4.0, respectively, P = 0.000) and had longer duration of gestation after cessation of ARBs (8.4 ± 5.2 vs. 0.7 ± 2.3 weeks, respectively, P = 0.000). The mothers without oligohydramnios also had better outcomes in terms of favorable infant outcomes (63% (15/24) vs. 15% (6/39), respectively, P = 0.000) and infant mortality rates (13% (3/24) vs. 56% (22/39), respectively, P = 0.001) than the 39 with oligohydramnios. Thus, a favorable outcome may be feasible if the fetuses are not indicated for prompt delivery at presentation and exhibit normal AFV or resolution of oligohydramnios after cessation of ARBs. Although the prevalence rate of oligohydramnios was high in this study, it may have been due to publication bias. A prospective study suggested a lower prevalence rate than that reported in the present study.

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Perinatal/Neonatal Case Presentation: Neonatal Acute Renal Failure Secondary to Maternal Exposure to Telmisartan, Angiotensin II Receptor Antagonist

Cited by 35 publications

References 7 publications

Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

Increased renal echogenicity in a preterm neonate: Answer

Outcomes of 83 fetuses exposed to angiotensin receptor blockers during the second or third trimesters: a literature review

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