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BMJ. 2007 September 8; 335(7618): 474.
PMCID: PMC1971207
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ACE inhibitor fetopathy may have long term implications

Long term follow-up of three children whose mothers in pregnancy had received the angiotensin converting enzyme (ACE) inhibitor enalapril found that two had impaired renal function, one had severe hypertension and proteinuria, and all three had polycythaemia.

One child was found to be hypertensive at age 10 years and by the age of 14 had mild renal failure (glomerular filtration rate 60 ml/min/1.73m2); between the age of 16 and 18 he required five phlebotomies for polycythaemia. Another child had shown a moderate fall in glomerular filtration rate since the age of 3 years (96 ml/min/1.73m2 at age 12.8 years) associated with mild proteinuria and isolated polycythaemia. The third child had normal renal function but low to normal concentrations of serum erythropoietin.

All three children had transient acute anuric renal failure as neonates (a recognised adverse effect of the mother taking an ACE inhibitor during pregnancy), hypoperfusion of the fetal kidney being a key mechanism in renal tubular dysgenesis.

The authors recommend careful follow-up of all children with ACE inhibitor fetopathy.

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