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A newborn girl had chronic renal failure following prenatal exposure to an angiotensin-converting enzyme (ACE) inhibitor, and a young infant with congenital nephrotic syndrome, showed persistent hypotension with neurological complications following bilateral nephrectomy at the age of 4 months. Both died. The renin-angiotensin system (RAS) is well-known for its regulatory function with respect to blood pressure, renal haemodynamics, fluid balance and electrolyte balance. Furthermore, its role in growth and differentiation of the kidneys and urinary tracts is becoming clearer. The RAS is highly important for the foetus and young infant. Extreme caution should be exercised with prenatal exposure to ACE inhibitors or angiotensin receptor blockers and bilateral nephrectomy in young infants.
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