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Saha AK, Padhi P, Hota D, Rathore V. Neonatal Acute Kidney Injury due to Maternal Olmesartan Intake: Authors' Reply. Indian J Pediatr 2024:10.1007/s12098-024-05167-1. [PMID: 38801495 DOI: 10.1007/s12098-024-05167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Anish Kumar Saha
- Department of Nephrology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Phalguni Padhi
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Dayanand Hota
- Department of Pediatrics, Directorate of Health Services, Raipur, Chhattisgarh, India
| | - Vinay Rathore
- Department of Nephrology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
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Michel C, Simon E. [Angiotensin-converting enzyme inhibitor and fetal nephromegaly]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:497-498. [PMID: 35081451 DOI: 10.1016/j.gofs.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Affiliation(s)
- C Michel
- Service de gynécologie obstétrique, médecine fœtale et stérilité conjugale, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - E Simon
- Service de gynécologie obstétrique, médecine fœtale et stérilité conjugale, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Université Bourgogne Franche-Comté, Dijon, France
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Saunders J, Callejas Salgado AM, Ting JY, Mammen C, Terry J, Bush JW. Quantifying Proximal Collecting Tubule Deficiency in Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Fetopathy. Pediatr Dev Pathol 2021; 24:438-444. [PMID: 34082612 DOI: 10.1177/10935266211018922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers (AAs) are used for several indications, with cessation recommended in pregnancy due to toxic effects. AA fetopathy phenotype is similar to renal tubular dysgenesis including reduced proximal convoluted tubules (PCTs). Our study aimed to quantify the reduction of PCTs in fetuses and infants with prenatal exposure to AAs. MATERIALS AND METHODS We identified 5 fetal AA exposure cases that underwent autopsy at our institution between 2011 and 2018 and compared with 5 gestational age-matched controls. Immunohistochemistry with CD10 and epithelial membrane antigen (EMA) was utilized. RESULTS CD10 and EMA identified a median PCT density of 19.0% ± 12.3% in AA fetopathy patients, significantly less than controls (52.8% ± 4.4%; p < 0.0001). One case with in utero cessation had a PCT density of 34.2% ± 0.2%. Among other AA fetopathy findings, 1 case demonstrated unilateral renal vein thrombosis and 4 had hypocalvaria. CONCLUSIONS We have quantified the reduction in AA fetopathy PCT density, and demonstrated in utero cessation may recover PCT differentiation. Future studies may benefit from calculating PCT percentage as a potential biomarker to correlate with post-natal renal function and maternal factors including medication type, dosage, duration, and time from medication cessation.
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Affiliation(s)
- Jessica Saunders
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Hospital and Health Center, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Joseph Y Ting
- Section of Neonatology, British Columbia Children's Hospital and Women's Hospital and Health Center, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Cherry Mammen
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.,Division of Nephrology, British Columbia Children's Hospital and Women's Hospital and Health Center, Vancouver, Canada
| | - Jefferson Terry
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Hospital and Health Center, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jonathan W Bush
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Hospital and Health Center, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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Kessel F, Steglich A, Hickmann L, Lira-Martinez R, Gerlach M, Sequeira-Lopez ML, Gomez RA, Hugo C, Todorov VT. Patterns of differentiation of renin lineage cells during nephrogenesis. Am J Physiol Renal Physiol 2021; 321:F378-F388. [PMID: 34338032 DOI: 10.1152/ajprenal.00151.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Developmentally heterogeneous renin expressing cells serve as progenitors for mural, glomerular and tubular cells during nephrogenesis and are collectively termed renin lineage cells (RLCs). In this study, we quantified different renal vascular and tubular cell types based on specific markers, assessed proliferation, and de-novo differentiation in the RLC population. We used kidney sections of mRenCre-mT/mG mice throughout nephrogenesis. Marker positivity was evaluated in whole digitalized sections. At embryonic day 16, RLCs appeared in the developing kidney, and expression of all stained markers in RLCs was observed. The proliferation rate of RLCs did not differ from the proliferation rate of non-RLCs. The RLCs expanded mainly by de-novo differentiation (neogenesis). The fractions of RLCs originating from the stromal progenitors of the metanephric mesenchyme (renin producing cells, vascular smooth muscle cells, mesangial cells) decreased during nephrogenesis. In contrast, aquaporin 2 positive RLCs in the collecting duct system that embryonically emerges almost exclusively from the ureteric bud, expanded postpartum. The cubilin positive RLC fraction in the proximal tubule, deriving from the cap mesenchyme, remained constant. During nephrogenesis, RLCs were continuously detectable in the vascular and tubular compartments of the kidney. Therein, various patterns of RLC differentiation that depend on the embryonic origin of the cells were identified.
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Affiliation(s)
- Friederike Kessel
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Anne Steglich
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Linda Hickmann
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,Institute of Physiology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ricardo Lira-Martinez
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Michael Gerlach
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,Core Facility Cellular Imaging (CFCI), University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Maria Luisa Sequeira-Lopez
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
| | - R Ariel Gomez
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
| | - Christian Hugo
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Vladimir T Todorov
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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5
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Schrankl J, Fuchs M, Broeker K, Daniel C, Kurtz A, Wagner C. Localization of angiotensin II type 1 receptor gene expression in rodent and human kidneys. Am J Physiol Renal Physiol 2021; 320:F644-F653. [PMID: 33615887 DOI: 10.1152/ajprenal.00550.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The kidneys are an important target for angiotensin II (ANG II). In adult kidneys, the effects of ANG II are mediated mainly by ANG II type 1 (AT1) receptors. AT1 receptor expression has been reported for a variety of different cell types within the kidneys, suggesting a broad spectrum of actions for ANG II. Since there have been heterogeneous results in the literature regarding the intrarenal distribution of AT1 receptors, this study aimed to obtain a comprehensive overview about the localization of AT1 receptor expression in mouse, rat, and human kidneys. Using the cell-specific and high-resolution RNAscope technique, we performed colocalization experiments with various cell markers to specifically discriminate between different segments of the tubular and vascular system. Overall, we found a similar pattern of AT1 mRNA expression in mouse, rat, and human kidneys. AT1 receptors were detected in mesangial cells and renin-producing cells. In addition, AT1 mRNA was found in interstitial cells of the cortex and outer medulla. In rodents, late afferent and early efferent arterioles expressed AT1 receptor mRNA, but larger vessels of the investigated species showed no AT1 expression. Tubular expression of AT1 mRNA was species dependent with a strong expression in proximal tubules of mice, whereas expression was undetectable in human tubular cells. These findings suggest that the (juxta)glomerular area and tubulointerstitium are conserved expression sites for AT1 receptors across species and might present the main target sites for ANG II in adult human and rodent kidneys.NEW & NOTEWORTHY Angiotensin II (ANG II) type 1 (AT1) receptors are essential for mediating the effects of ANG II in the kidneys. This study aimed to obtain a comprehensive overview about the cell-specific localization of AT1 receptor expression in rodent and human kidneys using the novel RNAscope technique. We found that the conserved AT1 receptor mRNA expression sites across species are the (juxta)glomerular areas and tubulointerstitium, which might present main target sites for ANG II in adult human and rodent kidneys.
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Affiliation(s)
- Julia Schrankl
- Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Michaela Fuchs
- Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Katharina Broeker
- Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Christoph Daniel
- Department of Nephropathology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Armin Kurtz
- Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Charlotte Wagner
- Institute of Physiology, University of Regensburg, Regensburg, Germany
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6
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Fetotoxic risk of AT1 blockers exceeds that of angiotensin-converting enzyme inhibitors: an observational study. J Hypertens 2020; 38:133-141. [PMID: 31568057 DOI: 10.1097/hjh.0000000000002233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The fetotoxic potential of prenatal exposure to angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) has been known for many years. Symptoms range from transient oligohydramnios to neonatal anuria and permanent renal damage, joint contractures, hypocalvaria, lung hypoplasia and intrauterine or neonatal death. This study aims to investigate the critical gestational time for renin-angiotensin system inhibitor (RAS-I)-induced fetopathy, to quantify the fetopathy risk and to evaluate factors associated with the occurrence and severity of fetopathy. METHODS Prospectively and retrospectively ascertained RAS-I exposed pregnancies from the databases of six teratology information services were analyzed. RESULTS Eighty-nine pregnancies with ACE-I and 101 with ARB exposure beyond the first trimester were identified. Fifty-nine of these 190 pregnancies were classified as having evidence of RAS-I fetopathy. All pregnancies affected with fetopathy were exposed after 20 0/7 gestational weeks. Limited to prospectively enrolled cases with exposure at least 20 0/7 gestational weeks, the rate of fetopathy was 3.2% for ACE-I and 29.2% for ARB. The chance of recovery of amniotic fluid volume was higher with RAS-I discontinuation before 30 gestational weeks and with a longer exposure-free interval before delivery. CONCLUSION Exposure to ARBs is associated with a higher fetopathy risk than exposure to ACE-Is. RAS-I should ideally be discontinued prior to pregnancy or immediately after recognition of pregnancy. Because symptoms may improve in cases of RAS-I-induced oligohydramnios, pregnancy should be maintained as long as there is fetal well being. Physicians and patients need to be alerted to the fetotoxic risks of RAS-I.
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7
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Buawangpong N, Teekachunhatean S, Koonrungsesomboon N. Adverse pregnancy outcomes associated with first-trimester exposure to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers: A systematic review and meta-analysis. Pharmacol Res Perspect 2020; 8:e00644. [PMID: 32815286 PMCID: PMC7438312 DOI: 10.1002/prp2.644] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
This study aimed to determine the effects of prenatal exposure to angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), particularly when exposure is limited to the first trimester of pregnancy, on adverse maternal and neonatal outcomes. A systematic search was performed on four databases, that is, PubMed, Scopus, Web of Science, and Cochrane Library, to identify relevant articles published up to December 31, 2019. Included studies were limited to original investigations assessing the association between prenatal exposure to ACEIs/ARBs and adverse pregnancy outcomes. Odds ratios were used as a summary effect measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis. The main outcomes included overall and specific congenital malformations, low birth weight, miscarriage, elective termination of pregnancy, stillbirth, and preterm delivery. Of 19 included articles involving a total of 4 163 753 pregnant women, 13 studies reported an increased risk of, at least, one adverse pregnancy outcome in pregnant women who were exposed to ACEIs/ARBs. Meta-analysis revealed a significant association between overall congenital malformations and first trimester-only exposure to ACEIs/ARBs (OR = 1.94, 95% CI = 1.71-2.21, P < .0001). Cardiovascular malformations, miscarriage, and stillbirth also provided a significant relation with ACEI/ARB exposure. In conclusion, prenatal exposure to ACEIs/ARBs in the first trimester of pregnancy was found to be associated with an increased risk of adverse pregnancy outcomes. Women of reproductive age should be aware of the potential teratogenic risks of these drugs if they become pregnant.
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Affiliation(s)
- Nida Buawangpong
- Department of Family MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | | | - Nut Koonrungsesomboon
- Department of PharmacologyFaculty of MedicineChiang Mai UniversityChiang MaiThailand
- Musculoskeletal Science and Translational Research CenterChiang Mai UniversityChiang MaiThailand
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Min J, Cho MH, Bae SP, Shin SH, Ha IS, Cheong HI, Kang HG. A Premature Baby with Severe Oligohydramnios and Hypotension: a Case Report of Renal Tubular Dysgenesis. J Korean Med Sci 2020; 35:e283. [PMID: 32808512 PMCID: PMC7431287 DOI: 10.3346/jkms.2020.35.e283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022] Open
Abstract
Renal tubular dysgenesis (RTD) is a rare fatal disorder in which there is poor development of proximal tubules, leading to oligohydramnios and the Potter sequences. RTD occurs secondary to renin-angiotensin system (RAS) blockade during the early stages of fetal development or due to autosomal recessive mutation of genes in the RAS pathway. A boy born at 33+1 weeks due to cord prolapse was found to be anuric and hypotensive. Pregnancy was complicated by severe oligohydramnios from gestational age 28+4 weeks. Abdominal sonography revealed diffuse globular enlargement of both kidneys with increased cortical parenchymal echogenicity. Infantogram showed a narrow thoracic cage and skull X-ray showed large fontanelles and wide sutures suggestive of ossification delay. Basal plasma renin activity was markedly elevated and angiotensin-converting enzyme was undetectable. Despite adequate use of medications, peritoneal dialysis, and respiratory support, he did not recover and expired on the 23rd day of life. At first, autosomal recessive polycystic kidney disease was suspected, but severe oligohydramnios along with refractory hypotension, anuria, skull ossification delay and high renin levels made RTD suspicious. ACE gene analysis revealed compound heterozygous pathogenic variations of c.1454.dupC in exon 9 and c.2141dupA in exon 14, confirming RTD. Based on our findings, we propose that, although rare, RTD should be suspected in patients with severe oligohydramnios and refractory hypotension.
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Affiliation(s)
- Jeesu Min
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Wide River Institute of Immunology, Seoul National University, Seoul, Korea.
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9
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Renin-angiotensin system blockers exposure in utero: a life-long risk for the offspring health. J Hypertens 2019; 38:35-37. [PMID: 31790019 DOI: 10.1097/hjh.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Schrankl J, Neubauer B, Fuchs M, Gerl K, Wagner C, Kurtz A. Apparently normal kidney development in mice with conditional disruption of ANG II-AT 1 receptor genes in FoxD1-positive stroma cell precursors. Am J Physiol Renal Physiol 2019; 316:F1191-F1200. [PMID: 30969804 DOI: 10.1152/ajprenal.00305.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An intact renin-angiotensin system involving ANG II type 1 (AT1) receptors is crucial for normal kidney development. It is still unclear in which cell types AT1 receptor signaling is required for normal kidney development, maturation, and function. Because all kidney cells deriving from stroma progenitor cells express AT1 receptors and because stromal cells fundamentally influence nephrogenesis and tubular maturation, we investigated the relevance of AT1 receptors in stromal progenitors and their descendants for renal development and function. For this aim, we generated and analyzed mice with conditional deletion of AT1A receptor in the FoxD1 cell lineage in combination with global disruption of the AT1B receptor gene. These FoxD1-AT1ko mice developed normally. Their kidneys showed neither structural nor functional abnormalities compared with wild-type mice, whereas in isolated perfused FoxD1-AT1ko kidneys, the vasoconstrictor and renin inhibitory effects of ANG II were absent. In vivo, however, plasma renin concentration and renal renin expression were normal in FoxD1-AT1ko mice, as were blood pressure and glomerular filtration rate. These findings suggest that a strong reduction of AT1 receptors in renal stromal progenitors and their descendants does not disturb normal kidney development.
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Affiliation(s)
- Julia Schrankl
- Institute of Physiology, University of Regensburg , Regensburg , Germany
| | - Bjoern Neubauer
- Department of Medicine IV, University Medical Center Freiburg , Freiburg , Germany
| | - Michaela Fuchs
- Institute of Physiology, University of Regensburg , Regensburg , Germany
| | - Katharina Gerl
- Institute of Physiology, University of Regensburg , Regensburg , Germany
| | - Charlotte Wagner
- Institute of Physiology, University of Regensburg , Regensburg , Germany
| | - Armin Kurtz
- Institute of Physiology, University of Regensburg , Regensburg , Germany
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Lallemant M, Prévost S, Nobili F, Riethmuller D, Ramanah R, Seronde MF, Mottet N. Prenatal hypocalvaria after prolonged intrauterine exposure to angiotensin II receptor antagonists. J Renin Angiotensin Aldosterone Syst 2019; 19:1470320318810940. [PMID: 30394825 PMCID: PMC6243420 DOI: 10.1177/1470320318810940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case of prenatal exposure to angiotensin II receptor antagonists (ARA
II) from the beginning of pregnancy in a patient with a hypokinetic dilated
cardiomyopathy. This case report emphasizes the fetal renal impact of prolonged
intrauterine exposure to renin-angiotensin system (RAS) blockers, and highlights
that this exposure can cause severe prenatal hypocalvaria. This delayed
ossification can be reversible after birth, but the presence of anhydramnios
indicates an early and irreversible block of RAS blockers in the fetus that is
responsible for fetal kidney development abnormalities. This association carries
a high risk of neonatal death. Prolonged exposure to ARA II or other RAS
blockers remains prohibited throughout pregnancy.
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Affiliation(s)
- Marine Lallemant
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Sarah Prévost
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - François Nobili
- 2 Paediatric Nephrology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Didier Riethmuller
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Rajeev Ramanah
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Marie-France Seronde
- 3 Cardiology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Nicolas Mottet
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
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12
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Activation of Hypoxia Signaling in Stromal Progenitors Impairs Kidney Development. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:1496-1511. [PMID: 28527294 DOI: 10.1016/j.ajpath.2017.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 01/16/2023]
Abstract
Intrauterine hypoxia is a reason for impaired kidney development. The cellular and molecular pathways along which hypoxia exerts effects on nephrogenesis are not well understood. They are likely triggered by hypoxia-inducible transcription factors (HIFs), and their effects appear to be dependent on the cell compartment contributing to kidney formation. In this study, we investigated the effects of HIF activation in the developing renal stroma, which also essentially modulates nephron development from the metanephric mesenchyme. HIF activation was achieved by conditional deletion of the von Hippel-Lindau tumor suppressor (VHL) protein in the forkhead box FOXD1 cell lineage, from which stromal progenitors arise. The resulting kidneys showed maturation defects associated with early postnatal death. In particular, nephron formation, tubular maturation, and the differentiation of smooth muscle, renin, and mesangial cells were impaired. Erythropoietin expression was strongly enhanced. Codeletion of VHL together with HIF2A but not with HIF1A led to apparently normal kidneys, and the animals reached normal age but were anemic because of low erythropoietin levels. Stromal deletion of HIF2A or HIF1A alone did not affect kidney development. These findings emphasize the relevance of sufficient intrauterine oxygenation for normal renal stroma differentiation, suggesting that chronic activity of HIF2 in stromal progenitors impairs kidney development. Finally, these data confirm the concept that normal stroma function is essential for normal tubular differentiation.
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13
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Snauwaert E, Vande Walle J, De Bruyne P. Therapeutic efficacy and safety of ACE inhibitors in the hypertensive paediatric population: a review. Arch Dis Child 2017; 102:63-71. [PMID: 27682140 DOI: 10.1136/archdischild-2016-310582] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/08/2016] [Accepted: 09/04/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE Since 1997, strong incentives have been introduced worldwide to improve access to safe and effective medicines addressing the therapeutic needs of children. ACE inhibitors, the most prescribed antihypertensive drugs in the paediatric population, are one of the prototype drugs targeted by the legislation initiatives. Our purpose in assembling this review is to evaluate and describe the current evidence for the efficacy and safety profile of ACE inhibitors in the paediatric population. METHODS The authors made a descriptive review of the literature from 1980 to 2015 using the following search terms: hypertension, child, paediatric, ACE (inhibitors), renin-angiotensin aldosterone system, captopril, lisinopril, enalapril, ramipril and fosinopril. RESULTS A total of 16 studies evaluating efficacy and safety of ACE inhibitors were included in this review. The included studies demonstrate that ACE inhibitors have the potency to decrease the systolic and/or diastolic blood pressure with an overall favourable safety profile in a short-term period. More importantly, the incentives resulted in an improvement of the overall availability of paediatric labelling, dosing and safety information for ACE inhibitors. However, they failed to fulfil several of paediatric needs: absence of long-term safety data on growth and maturation, absence of commercially available child-friendly formulations and incomplete evaluation of the entire paediatric hypertension population. CONCLUSION Additional efforts are needed to close the gap between the availability of drugs that are labelled and indicated for paediatric use and the actual drug usage in children, especially in young children, neonates and children with severe hypertension, renal transplantation or severe renal impairment.
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Affiliation(s)
- Evelien Snauwaert
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | | | - Pauline De Bruyne
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
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