This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mahieu-Caputo, D. Articles by Gubler, M.-C. Search for Related Content PubMed PubMed Citation Articles by Mahieu-Caputo, D. Articles by Gubler, M.-C.

(American Journal of Pathology. 2000;156:629-636.)
© 2000 American Society for Investigative Pathology

Regular Articles

Twin-to-Twin Transfusion Syndrome

Role of the Fetal Renin-Angiotensin System

Dominique Mahieu-Caputo^*, Marc Dommergues^*, Anne-Lise Delezoide, Mireille Lacoste, Yi Cai, Françoise Narcy^§, Dominique Jolly^¶, Marie Gonzales^||, Yves Dumez^* and Marie-Claire Gubler

From the Departments of Obstetrics,^*
Histoembryology,
and Nephrology^¶
and Institut National de la Santé et de la Recherche Médicale Unité 423,
Hôpital Necker-Enfants Malades, Université René Descartes; the Department of Pathology,^§
Hôpital Cochin; and the Department of Histoembryology,^||
Hôpital Saint Antoine, Paris, France

The twin-to-twin transfusion syndrome (TTS) results from an unbalanced blood supply through placental anastomoses in monochorionic twins. It induces growth restriction, renal tubular dysgenesis, and oliguria in the donor and visceromegaly and polyuria in the recipient. A better understanding of its pathophysiology could contribute to improving the management of TTS, which still carries a high perinatal mortality in both twins. As well as several other candidates, the renin-angiotensin system might be involved in TTS. To evaluate its role in the pathogenesis of the syndrome, we studied the kidneys of 21 twin pairs who died from TTS at 19 to 30 weeks, compared with 39 individuals in a control group, using light microscopy, immunohistochemistry, and in situ hybridization. The overexpression of the renin protein and transcript with frequent evidence of renin synthesis by mesangial cells was observed in the donor kidneys, presumably as a consequence of chronic renal hypoperfusion. This upregulation of renin synthesis might be beneficial to restore euvolemia. In severe cases of TTS, however, angiotensin-II-induced vasoconstriction acts as an additional deleterious factor by further reducing the renal blood flow in donors. In recipients, renin expression was virtually absent, possibly because it was down-regulated by hypervolemia. However, in addition to congestion and hemorrhagic infarction, there were severe glomerular and arterial lesions resembling those observed in polycythemia- or hypertension-induced microangiopathy. We speculate that fetal hypertension in the recipient might be partly mediated by the transfer of circulating renin produced by the donor, through the placental vascular shunts.

This article has been cited by other articles:

				O. M. Faye-Petersen and T. M. Crombleholme Twin-to-Twin Transfusion Syndrome: Part 1. Types and Pathogenesis NeoReviews, September 1, 2008; 9(9): e370 - e379. [Abstract] [Full Text] [PDF]

				J. P. H. M. van den Wijngaard, B. E. Westerhof, M. G. Ross, and M. J. C. van Gemert A mathematical model of twin-twin transfusion syndrome with pulsatile arterial circulations Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2007; 292(4): R1519 - R1531. [Abstract] [Full Text] [PDF]

				J. P. H. M. van den Wijngaard, B. E. Westerhof, D. J. Faber, M. M. Ramsay, N. Westerhof, and M. J. C. van Gemert Abnormal arterial flows by a distributed model of the fetal circulation Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2006; 291(5): R1222 - R1233. [Abstract] [Full Text] [PDF]

				M. Lacoste, Y. Cai, L. Guicharnaud, F. Mounier, Y. Dumez, R. Bouvier, F. Dijoud, M. Gonzales, J. Chatten, A.-L. Delezoide, et al. Renal Tubular Dysgenesis, a Not Uncommon Autosomal Recessive Disorder Leading to Oligohydramnios: Role of the Renin-Angiotensin System J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2253 - 2263. [Abstract] [Full Text] [PDF]

				H M Gardiner Response of the fetal heart to changes in load: from hyperplasia to heart failure Heart, July 1, 2005; 91(7): 871 - 873. [Full Text] [PDF]

				J. P. H. M. van den Wijngaard, A. Umur, R. T. Krediet, M. G. Ross, and M. J. C. van Gemert Modeling a hydropic recipient twin in twin-twin transfusion syndrome Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2005; 288(4): R799 - R814. [Abstract] [Full Text] [PDF]

				M.J. Raboisson, J.C. Fouron, J. Lamoureux, L. Leduc, A. Grignon, F. Proulx, and S. Gamache Early Intertwin Differences in Myocardial Performance During the Twin-to-Twin Transfusion Syndrome Circulation, November 9, 2004; 110(19): 3043 - 3048. [Abstract] [Full Text] [PDF]

				N. M. Fisk and P. Galea Twin-Twin Transfusion -- As Good as It Gets? N. Engl. J. Med., July 8, 2004; 351(2): 182 - 184. [Full Text] [PDF]

				H. M. Gardiner, M. J.O. Taylor, A. Karatza, T. Vanderheyden, A. Huber, S. E. Greenwald, N. M. Fisk, and K. Hecher Twin-Twin Transfusion Syndrome: The Influence of Intrauterine Laser Photocoagulation on Arterial Distensibility in Childhood Circulation, April 15, 2003; 107(14): 1906 - 1911. [Abstract] [Full Text] [PDF]

				A A Karatza, J L Wolfenden, M J O Taylor, L Wee, N M Fisk, and H M Gardiner Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies Heart, September 1, 2002; 88(3): 271 - 277. [Abstract] [Full Text] [PDF]