PERSISTENT ANURIA, NEONATAL DEATH, AND RENAL MICROCYSTIC LESIONS AFTER PRENATAL EXPOSURE TO INDOMETHACIN

OBJECTIVE: The purpose of this study is to emphasize the high risk of renal failure and severe morphologic changes related to prolonged prenatal exposure to indomethacin. STUDY DESIGN: Referred renal specimens from six anuric neonates exposed in utero to indomethacin were studied. Clinical charts were retrospectively reviewed. Indomethacin dosages varied from 150 to 400 mg daily, and the drug was given for a 2- to 11-week period, until birth. RESULTS: All infants died in anuria, 4 of them after 7 to 39 days on peritoneal dialysis. In 5 infants cystic dilatations of superficial nephrons were associated with ischemic changes of the deep cortex. By immunohistochemical analysis intrarenal renin content was increased in 4 of 5 patients. CONCLUSION: Long-term indomethacin treatment during pregnancy may lead to the development of renal failure and irreversible renal damage with cystic dilatation of developing nephrons in an exposed. fetus. Prior stimulation of the renin-angiotensin system may favor this complication.