Reversible fetal renal failure after maternal treatment with Candesartan: a case report

Despite data suggesting that angiotensin-receptor blockers (ARBs) are associated with increased risk to the fetus, there has been an increasing exposure of ARBs in pregnancy. We report a case report regarding a woman, who accidentally was treated with Candesartan during the first 22 weeks of pregnancy. At 22 weeks of gestation the fetal kidneys were oedematous with very little amniotic fluid. The prognosis for the fetus was considered poor. Five weeks after discontinuation of Candesartan normal quantities of amnionic fluid and a visible fetal bladder was registered. After delivery at week 31, creatinine clearance, diuresis and urine examination of the neonate were within normal limits. Ultrasound examinations of the kidneys showed bilaterally marked calices, small cysts and parenchymal increased echogenety at 1 week with complete sonographic normalization at 6 weeks. However, experimental studies raise the question of potential long-term adverse effects, including renal dysfunction and arterial hypertension in adulthood.