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Antenatal corticosteroids and the renin-angiotensin-aldosterone system in adolescents born preterm

Andrew M South1,2, Patricia A Nixon1,3, Mark C Chappell2,4

  • 1Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina.

Pediatric Research
|September 17, 2016
PubMed

Insights

Antenatal corticosteroid (ANCS) exposure in premature infants may alter the renin-angiotensin system (RAAS) in adolescents. This study found ANCS exposure associated with urinary RAAS imbalance, potentially increasing long-term renal disease risk.

Area of Science:

  • Neonatal Medicine
  • Cardiovascular Physiology
  • Renal Pathophysiology

Background:

  • Antenatal corticosteroid (ANCS) treatment improves premature infant survival by enhancing lung maturity.
  • Long-term consequences of ANCS exposure are not fully understood.
  • Animal studies link ANCS to cardiovascular disease via the renin-angiotensin-aldosterone system (RAAS).

Purpose of the Study:

  • To investigate the hypothesis that ANCS exposure alters the RAAS in adolescents born prematurely.
  • To assess the impact of ANCS on key RAAS components in adolescent populations.

Main Methods:

  • A cohort of 173 prematurely born adolescents was studied, with 92 exposed to ANCS.
  • Plasma and urine levels of Angiotensin II (Ang II) and Ang-(1-7) were measured.
  • General linear regression models were used to compare RAAS markers between exposed and unexposed groups, adjusting for confounders.

Main Results:

  • ANCS exposure was linked to a higher urinary Ang II/Ang-(1-7) ratio (P = 0.03).
  • Increased plasma Ang-(1-7) (P = 0.002) and decreased plasma Ang II/Ang-(1-7) ratio (P = 0.03) were observed in ANCS-exposed adolescents.
  • These findings suggest a significant alteration in the RAAS following ANCS treatment.

Conclusions:

  • ANCS exposure leads to a urinary RAAS imbalance, favoring Ang II activity over Ang-(1-7).
  • This imbalance may elevate the risk of renal inflammation, fibrosis, hypertension, and kidney disease later in life.
  • Further research is warranted to understand the long-term renal and cardiovascular implications of ANCS exposure.
Abstract

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