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A male infant weighing 2,150 g was delivered. The Apgar scores were 7 at 1 minute and 9 at 5 minutes. At birth, he was meconium-stained. Birth weight and height of the infant were below the 10th percentile for its gestational age. His mother, a 38-year-old woman, was referred to our center at 36 weeks of gestation for intrauterine growth restriction and oligohydramnios detected at 30 weeks. It was her third pregnancy followed by 2 previous abortions (1 spontaneous abortion, 1 artificial abortion) that occurred 5 to 10 years ago. Reduced fetal movements had been noted in the preceding 4 weeks. Nothing relevant could be found other than oligohydramnios from antenatal ultrasound. She took a tablet of Sevikar (Daiichi Sankyo Europe GmbH, Munich, Germany) containing 40 mg of olmesartan medoxomil and 5 mg of amlodipine (as amlodipine besilate) once a day because of hypertension diagnosed 2 years before pregnancy and had smoked half a pack of cigarettes a day throughout pregnancy. She denied any family history of genetic diseases. The patient presented with respiratory failure and bilateral pneumothorax although there were no features of typical Potter sequence. He presented with rapid respiration and subcostal retraction on admission. His respiratory status continued to deteriorate and he received mechanical ventilation after surfactant administration. During the 1st day of life, he developed severe arterial hypotension (mean arterial blood pressure: 10–20 mmHg) which poorly responded to fluid boluses, catechola mine therapy (dopamine, dobutamine, noradrenaline, and epinephrine), and hydrocortisone therapy. On the 2nd hospital day, persistent pulmonary hypertension of the newborn (PPHN) was confirmed by Doppler echocardiography showing rightto-left shuntings through a widely patent ductus arteriosus and a patent foramen ovale and intravenous milrinone and inhaled nitric oxide were administered. He was anuric since birth, which persisted without response to fluid restriction after attempting fluid resuscitation or diuretic therapy. Renal ultrasonography demonstrated diffuse increased cortical echogenicity of the right and left kidneys and increased resistive index value of the left kidney (Fig. 1A–C). On the 5th day of life, acute peritoneal dialysis (PD) was started for persistent anuria and renal failure (serum creatinine, 3.76 mg/dL; blood urea nitrogen, 36.5 mg/

Secondary renal tubular dysgenesis in a newborn exposed to angiotensin Ⅱ receptor antagonist during gestation