The renin-angiotensin-aldosterone-system (RAAS) plays a pivotal role for normal kidney development. We present the case of a 34-year old second gravida who was treated with valsartan during the entire pregnancy and presented at 35 weeks of gestation with preterm labour and complete anhydramnios. After spontaneous delivery the eutrophic male infant showed typical signs of sartan fetotoxicity including neonatal anuria, enlarged hyperechogenic kidneys, initial arterial hypotension, limb contractures, skull bone hypoplasia and a narrow chest. During the first days of life arterial hypertension developed and persisted until last follow-up at 24 months. Antihypertensive therapy with amlodipine was necessary from 7 months of life until last follow-up.
Valsartan exposure especially during the second half of pregnancy causes valsartan fetotoxicity, which can lead to progressive arterial hypertension requiring antihypertensive medication. Close monitoring of patients with valsartan fetopathy is essential.