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Coelho ARDP, Silveira LC, Santos KDF, Santos RDS, Reis AADS. No Association of Angiotensin-Converting Enzyme Insertion/Deletion (ACE I/D) Gene Polymorphism in the Susceptibility to Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients: An Updated Meta-Analysis. J Pers Med 2023; 13:1308. [PMID: 37763076 PMCID: PMC10533192 DOI: 10.3390/jpm13091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Diabetic retinopathy (DR) is a complex and multifactorial pathology encompassing environmental, metabolic, and polygenic influences. Among the genes possibly involved in the development and progression of DR, the Angiotensin I-converting enzyme (ACE) gene stands out, which presents an insertion (I) or deletion (D) polymorphism of a 287 bp Alu repetitive sequence in intron 16. Thus, this study aimed to perform a systematic review with meta-analysis to elucidate the relationship between the ACE gene (I/D) polymorphism (rs1799752) and the development and progression of DR in type 2 diabetic patients. PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were systematically searched to retrieve articles that investigated the association between ACE gene (I/D) polymorphism in DR patients. Sixteen articles were included in the systematic review. The results describe no significant association between the polymorphism and DR risk (OR = 1.12; CI = 0.96-1.31; and p = 0.1359) for genotypic analysis by the dominant model (II vs. ID+DD). Moreover, we also observed no significant association between the D allele on the allele frequency analysis (I vs. D) and the DR risk (OR = 1.10; CI = 0.98-1.23; and p = 0.1182). Forest plot analysis revealed that the discrepancy between previous studies most likely arose from variations in their sample sizes. In conclusion, I/D polymorphism appears to be not involved in the susceptibility to and progression of the DR in type 2 diabetic patients.
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Affiliation(s)
- Aline Ruilowa de Pinho Coelho
- Laboratory of Molecular Pathology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
| | - Luciana Carvalho Silveira
- Laboratory of Molecular Pathology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
| | - Kamilla de Faria Santos
- Laboratory of Molecular Pathology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
| | - Rodrigo da Silva Santos
- Laboratory of Molecular Pathology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
- Department of Biochemistry and Molecular Biology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
| | - Angela Adamski da Silva Reis
- Laboratory of Molecular Pathology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
- Department of Biochemistry and Molecular Biology, Biological Sciences Institute, Federal University of Goiás, Goiânia 74690-090, Brazil
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Zeng WL, Yang SK, Song N, Chu FF. The impact of angiotensin converting enzyme insertion/deletion gene polymorphism on diabetic kidney disease: A debatable issue. Nefrologia 2022; 42:415-431. [PMID: 36460431 DOI: 10.1016/j.nefroe.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/21/2021] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the influence of ACE I/D gene polymorphisms on diabetic kidney disease (DKD) risk. METHODS All eligible investigations were identified, the number of various genotype in the case and control group were reviewed. The pooled analysis was performed using Stata software. RESULTS In overall subjects, 24,321 participants with 12,961 cases and 11,360 controls were included. the pooled analysis showed a significant link between D allele, DD or II genotype and DKD risk (D versus I: OR=1.316, 95% CI: 1.213-1.427, P=0.000; DD versus ID+II: OR=1.414, 95% CI: 1.253-1.595, P=0.000; II versus DD+ID: OR=0.750, 95% CI: 0.647-0.869, P=0.000). The subgroup pooled analysis showed that ACE I/D gene polymorphism was correlated with DKD both in Asian and in Chinese population. In addition, ACE I/D gene polymorphism was correlated with type 2 DKD (D versus I: OR=1.361, 95% CI: 1.243-1.490, P=0.000; DD versus ID+II: OR=1.503, 95% CI: 1.310-1.726, P=0.000; II versus DD+ID: OR=0.738, 95% CI: 0.626 -0.870, P=0.000). However, there was no obvious correlation in Caucasian subjects and type 1 diabetic patients. CONCLUSION ACE I/D polymorphisms were correlated with DKD in Asian and type 2 diabetic populations. ACE D allele/DD genotype might be a risk factor, while ACE II genotype might be a protective factor for DKD.
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Affiliation(s)
- Wen-Li Zeng
- Department of Nephrology, The First Affiliated Hospital of the University of South China, Hengyang 421001, Hunan Province, China
| | - Shi-Kun Yang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Na Song
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Fen-Fen Chu
- Department of Nephrology, The First Affiliated Hospital of the University of South China, Hengyang 421001, Hunan Province, China.
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Zeng WL, Yang SK, Song N, Chu FF. The impact of angiotensin converting enzyme insertion/deletion gene polymorphism on diabetic kidney disease: A debatable issue. Nefrologia 2021; 42:S0211-6995(21)00158-2. [PMID: 34503862 DOI: 10.1016/j.nefro.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the influence of ACE I/D gene polymorphisms on diabetic kidney disease (DKD) risk. METHODS All eligible investigations were identified, the number of various genotype in the case and control group were reviewed. The pooled analysis was performed using Stata software. RESULTS In overall subjects, 24,321 participants with 12,961 cases and 11,360 controls were included. the pooled analysis showed a significant link between D allele, DD or II genotype and DKD risk (D versus I: OR=1.316, 95% CI: 1.213-1.427, P=0.000; DD versus ID+II: OR=1.414, 95% CI: 1.253-1.595, P=0.000; II versus DD+ID: OR=0.750, 95% CI: 0.647-0.869, P=0.000). The subgroup pooled analysis showed that ACE I/D gene polymorphism was correlated with DKD both in Asian and in Chinese population. In addition, ACE I/D gene polymorphism was correlated with type 2 DKD (D versus I: OR=1.361, 95% CI: 1.243-1.490, P=0.000; DD versus ID+II: OR=1.503, 95% CI: 1.310-1.726, P=0.000; II versus DD+ID: OR=0.738, 95% CI: 0.626 -0.870, P=0.000). However, there was no obvious correlation in Caucasian subjects and type 1 diabetic patients. CONCLUSION ACE I/D polymorphisms were correlated with DKD in Asian and type 2 diabetic populations. ACE D allele/DD genotype might be a risk factor, while ACE II genotype might be a protective factor for DKD.
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Affiliation(s)
- Wen-Li Zeng
- Department of Nephrology, The First Affiliated Hospital of the University of South China, Hengyang 421001, Hunan Province, China
| | - Shi-Kun Yang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Na Song
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Fen-Fen Chu
- Department of Nephrology, The First Affiliated Hospital of the University of South China, Hengyang 421001, Hunan Province, China.
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Lu M, Zhang J, Li M, Ge X, Dai X, Zhao J, Fu M, Wang T, Fang X, Li C, Zhang R, Zhao W, Zheng T, Wang F, Yu M, Lei T, Wang N, Bao Y, Liu L, Liu Y, Jia W. The angiotensin-I converting enzyme gene I/D variation contributes to end-stage renal disease risk in Chinese patients with type 2 diabetes receiving hemodialysis. Mol Cell Biochem 2016; 422:181-188. [PMID: 27633502 DOI: 10.1007/s11010-016-2819-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
Abstract
Whether the DD genotype of the angiotensin-I converting enzyme (ACE) I/D variation contributes to end-stage renal disease (ESRD) risk in type 2 diabetes mellitus (T2DM) remains controversial. Differences in study design, case and control definition, sample size and ethnicity may contribute to the discrepancies reported in association studies. We performed a case-control study to evaluate the association of the ACE I/D variation with ESRD risk in Chinese patients with T2DM receiving hemodialysis and analyzed the genotype-phenotype interaction. Unrelated Chinese patients (n = 432) were classified into the non-diabetic nephropathy (DN) control group (n = 222, duration of diabetes >10 years, no signs of renal involvement) and the DN-ESRD group (n = 210; ESRD due to T2DM, receiving hemodialysis). Polymerase chain reaction was used to genotype ACE I/D for all 432 subjects. The frequencies of the ID + DD genotypes were higher in the DN-ESRD group than non-DN control group (65.2 vs. 50.9 %; adjusted OR 1.98 (95 % CI, 1.31-3.00; P = 0.001). In the DN-ESRD group, the DD genotypic subgroup had significantly elevated HbA1c and diastolic blood pressure (DBP) compared to the II subgroup (both P < 0.05). The DD genotype of the ACE I/D variation may be associated with more elevated blood pressure and HbA1c, and therefore may predict the development, progression and severity of DN-ESRD in Chinese patients with T2DM undergoing hemodialysis.
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Affiliation(s)
- Ming Lu
- Department of Endocrinology & Metabolism, Putuo Hospital Attached to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Shanghai, 200000, China
| | - Jianzhong Zhang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, 829 Xinmin Street, Changchun, China
| | - Ming Li
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Xiaoxu Ge
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Xu Dai
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Jiao Zhao
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Mingzhou Fu
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Tao Wang
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Xiyao Fang
- Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China
| | - Can Li
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Rong Zhang
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Weijing Zhao
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Taishan Zheng
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Feng Wang
- Department of Nephrology, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Ming Yu
- Department of Endocrinology & Metabolism, Putuo Hospital Attached to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Shanghai, 200000, China
| | - Tao Lei
- Department of Endocrinology & Metabolism, Putuo Hospital Attached to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Shanghai, 200000, China
| | - Niansong Wang
- Department of Nephrology, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yuqian Bao
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Limei Liu
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Yanjun Liu
- Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Sciences, University of California Los Angeles (UCLA) School of Medicine, Los Angeles, CA, USA
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Diabetes Institute, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
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Fathi M, Nikzamir AR, Esteghamati A, Nakhjavani M, Yekaninejad MS. Combination of Angiotensin Converting Enzyme Insertion/Deletion (I/D) (rs4646994) and VEGF Polymorphism (+405G/C; rs2010963) Synergistically Associated With the Development, of Albuminuria in Iranian Patients With Type 2 Diabetes. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e19469. [PMID: 25834741 PMCID: PMC4376980 DOI: 10.5812/ircmj.19469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/25/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) and vascular endothelial growth factor (VEGF) polymorphisms have been shown to associate with diabetic nephropathy (DN). OBJECTIVES We examined the hypothesis that ACE-D and VEGF-G alleles act synergistically in association with DN, in patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS The VEGF (rs2010963) and ACE (rs4646994) genotypes were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 490 T2DM patients. Diabetic patients were classified as T2DM patients with and without albuminuria (control). The PCR and RFLP were used to detect the VEGF and ACE alleles. RESULTS A total of 255 consecutive patients with T2DM and microalbuminuria (Group A) and 235 patients with T2DM and normoalbuminuria (Group B) were included in the study. In univariate analysis, the groups were statistically similar for all variables, except for glycated hemoglobin (HbA1c) (P = 0.034), and the frequency of ACE (P = 0.015) and VEGF (P = 0.006) genotypes. Our study showed that the VEGF-G and ACE-D alleles are independently associated with the development of nephropathy. According to our data, the combination of these two risk factors had a significant synergistic effect on the risk of microalbuminuria development. CONCLUSIONS Our study indicated that ACE-D and VEGF-G alleles can be an independent risk factor for microalbominuria in T2DM patients.
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Affiliation(s)
- Mohammad Fathi
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Abdol Rahim Nikzamir
- Department of Biochemistry, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Endocrinology and Metabolism Research Center (EMRC), Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Abdol Rahim Nikzamir, Department of Biochemistry, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166948671, Fax: +98-2166948671, E-mail:
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran
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Lin C, Yang HY, Wu CC, Lee HS, Lin YF, Lu KC, Chu CM, Lin FH, Kao SY, Su SL. Angiotensin-converting enzyme insertion/deletion polymorphism contributes high risk for chronic kidney disease in Asian male with hypertension--a meta-regression analysis of 98 observational studies. PLoS One 2014; 9:e87604. [PMID: 24498151 PMCID: PMC3909221 DOI: 10.1371/journal.pone.0087604] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/24/2013] [Indexed: 12/22/2022] Open
Abstract
Background Associations between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms and chronic kidney disease (CKD) have been extensively studied, with most studies reporting that individuals with the D allele have a higher risk. Although some factors, such as ethnicity, may moderate the association between ACE I/D polymorphisms and CKD risk, gender-dependent effects on the CKD risk remain controversial. Objectives This study investigated the gender-dependent effects of ACE I/D polymorphisms on CKD risk. Data sources PubMed, the Cochrane library, and EMBASE were searched for studies published before January 2013. Study eligibility criteria, participants, and interventions Cross-sectional surveys and case–control studies analyzing ACE I/D polymorphisms and CKD were included. They were required to match the following criteria: age >18 years, absence of rare diseases, and Asian or Caucasian ethnicity. Study appraisal and synthesis methods The effect of carrying the D allele on CKD risk was assessed by meta-analysis and meta-regression using random-effects models. Results Ethnicity [odds ratio (OR): 1.24; 95% confidence interval (CI): 1.08–1.42] and hypertension (OR: 1.55; 95% CI: 1.04–2.32) had significant moderate effects on the association between ACE I/D polymorphisms and CKD risk, but they were not significant in the diabetic nephropathy subgroup. Males had higher OR for the association between ACE I/D polymorphisms and CKD risk than females in Asians but not Caucasians, regardless of adjustment for hypertension (p<0.05). In subgroup analyses, this result was significant in the nondiabetic nephropathy group. Compared with the I allele, the D allele had the highest risk (OR: 3.75; 95% CI: 1.84–7.65) for CKD in hypertensive Asian males. Conclusions and implications of key findings The ACE I/D polymorphisms may incur the highest risk for increasing CKD in hypertensive Asian males.
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Affiliation(s)
- Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-Yi Yang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Herng-Sheng Lee
- Division of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- * E-mail:
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Ha SK. ACE insertion/deletion polymorphism and diabetic nephropathy: clinical implications of genetic information. J Diabetes Res 2014; 2014:846068. [PMID: 25587546 PMCID: PMC4284953 DOI: 10.1155/2014/846068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022] Open
Abstract
Approximately 20-40% of diabetic patients develop nephropathy which is the leading cause of ESRD in developed countries. The ACE I/D polymorphism is thought to be a marker for functional polymorphism which regulates circulating and tissue ACE activity. While the initial study found a protective effect of the II genotype on the development of nephropathy in IDDM patients, subsequent studies have addressed the role of ACE I/D polymorphism in the development and progression of diabetic nephropathy. RAAS blockers are the first line drugs for the treatment hypertension associated with diabetes and have been widely used in everyday clinical practice for the purpose of reducing proteinuria in patients with various renal diseases. However, the antiproteinuric effect of RAAS blockers is variable and the percentage of reducing proteinuria is in the range of 20-80%. The antiproteinuric effect of RAAS blockers may be related to a number of factors: the type or the dose of RAAS blockers, the duration of therapy, the level of sodium intake, and the type of patient's ACE I/D genotype. Besides the nongenetic factors, drug responses, can be influenced by ACE gene polymorphism. In this review, we discuss the relationship between ACE I/D polymorphism and diabetic nephropathy and therapeutic response of RAAS blockers.
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Affiliation(s)
- Sung-Kyu Ha
- Renal Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Dogok-Dong, Gangnam-Gu, Seoul 146-92, Republic of Korea
- *Sung-Kyu Ha:
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Yu ZY, Chen LS, Zhang LC, Zhou TB. Meta-analysis of the relationship between ACE I/D gene polymorphism and end-stage renal disease in patients with diabetic nephropathy. Nephrology (Carlton) 2012; 17:480-7. [PMID: 22385293 DOI: 10.1111/j.1440-1797.2012.01592.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Diabetic nephropathy (DN) is the major cause for end-stage renal disease (ESRD) and the pathogenesis for DN developing into ESRD is not clear at present. Results from published studies on the relationship between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and ESRD risk in DN patients are still conflicting. This meta-analysis was performed to evaluate the association between ACE I/D gene polymorphism and ESRD risk in DN patients. METHODS Association studies were identified from the databases of PubMed, Embase and Cochrane Library on 1 October 2011, and eligible investigations were identified and synthesized using the meta-analysis method. Results were expressed using odds ratios (OR) for dichotomous data and 95% confidence intervals (CI) were also calculated. RESULTS Twelve studies reporting the relation between ACE I/D gene polymorphism and ESRD risk in DN patients were identified. In overall populations, there was a notable association between D allele or DD genotype and ESRD susceptibility (D: OR = 1.32, 95% CI: 1.11-1.56, P = 0.002; DD: OR = 1.67, 95% CI: 1.25-2.21, P = 0.0004). In the sub-group analysis according to ethnicity, D allele or DD genotype was associated with ESRD risk in Asians. In Caucasians, the association of DD genotype with ESRD risk was observed, but the D allele was not. Furthermore, ACE I/D gene polymorphism was associated with ESRD risk in patients with DN due to diabetes mellitus type 2, but the association was not found for patients with DN due to diabetes mellitus type-1. CONCLUSIONS Our results indicate that D allele or DD homozygous is associated with the ESRD susceptibility in DN patients. However, more investigations are required to further this association.
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Affiliation(s)
- Ze-Yan Yu
- Postgraduate School of GuangXi Medical University, Nanning, Guangxi, China
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Zhou TB, Yin SS, Qin YH. Association between angiotensin-converting enzyme insertion/deletion gene polymorphism and end-stage renal disease susceptibility. J Renin Angiotensin Aldosterone Syst 2012; 15:22-31. [PMID: 23077080 DOI: 10.1177/1470320312460898] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Tian-Biao Zhou
- Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, China
| | - Sheng-Sheng Yin
- Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, China
| | - Yuan-Han Qin
- Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, China
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10
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Angiotensin-converting enzyme gene polymorphisms and T2DM in a case–control association study of the Bahraini population. Mol Cell Biochem 2011; 350:119-25. [DOI: 10.1007/s11010-010-0688-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
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Geara AS, Azzi J, Jurewicz M, Abdi R. The renin-angiotensin system: an old, newly discovered player in immunoregulation. Transplant Rev (Orlando) 2009; 23:151-8. [PMID: 19539879 DOI: 10.1016/j.trre.2009.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Clinical and experimental studies that discuss the different immune functions of the renin-angiotensin system (RAS) in kidney diseases were reviewed, with emphasis on studies of kidney transplantation. The RAS has been shown to affect both the innate and adaptive immune responses and has a well-established role in fibrinogenesis. Of special clinical interest is the ability of the RAS to activate the transforming growth factor beta(1) and the Smad pathways leading to fibrinogenesis. In addition to the RAS enhancing effect on the activity of T cells, several components of the RAS have also been shown to be chemotactic to macrophages, T cells, and natural killer cells. Experimental studies have found that RAS blockade decreases the histologic lesions of chronic allograft nephropathy but can enhance acute graft vasculopathy. Although the blockade of RAS has been commonly practiced to reduce posttransplantation hypertension, proteinuria, and erythrocytosis, however, its role in prolonging graft survival is not well established.
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Affiliation(s)
- Abdallah S Geara
- Internal Medicine Department, Staten Island University Hospital, Staten Island, NY 10305, USA
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Nikzamir A, Esteghamati A, Feghhi M, Nakhjavani M, Rashidi A, Reza JZ. The insertion/deletion polymorphism of the angiotensin-converting enzyme gene is associated with progression, but not development, of albuminuria in Iranian patients with type 2 diabetes. J Renin Angiotensin Aldosterone Syst 2009; 10:109-14. [PMID: 19502259 DOI: 10.1177/1470320309104872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been shown to be associated with a number of complications of type 2 diabetes. RESULTS on the development and progression of albuminuria, however, have remained controversial, with ethnic differences being a potential reason.The present study is the first report to examine Iranian patients. METHODS Patients (322; 162 males) with type 2 diabetes were categorised in this cross-sectional study into the following groups: normoalbuminuria (n=145), microalbuminuria (n=129) and macroalbuminuria (n=48).ACE gen I/D polymorphism genotypes were determined using the polymerase chain reaction method. RESULT s. The distribution of ACE genotypes was significantly different among the groups (p<0.001), with the II genotype decreasing and the DD genotype increasing in frequency with increasing severity of albuminuria. Multivariate regression analysis showed that the ACE genotype did not change the odds of having microalbuminuria versus normoalbuminuria, while the D allele independently increased the odds of having macroalbuminuria versus microalbuminuria approximately threefold (p<0.01). CONCLUSIONS In Iranian patients with type 2 diabetes, the D allele is associated with progression, but not development, of albuminuria.
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Affiliation(s)
- Abdolrahim Nikzamir
- Department of Biochemistry, Faculty of Medicine, Ahwaz Jondi Shapour University of Medical Sciences, Ahwaz, Iran
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Buraczynska M. Genetic predictors of renal failure. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2008; 2:651-664. [PMID: 23495776 DOI: 10.1517/17530059.2.6.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Both environmental and genetic factors contribute to the development and progression of chronic kidney disease. The completion of the human genome sequence and advances in genomic technology make possible identification of gene variants associated with renal failure. OBJECTIVE This review discusses the relevant genetic studies in chronic kidney disease, with particular emphasis on the most common causes of end stage renal failure, diabetic nephropathy and glomerulonephritis. METHODS Most of the studies presented were performed in recent years and employed association studies, both population-based and with candidate genes, as well as the genome-wide association and genome-wide scan approaches. RESULTS/CONCLUSION Increasing evidence supports an important role of genetic susceptibility in the development and progression of renal failure. Identification of disease genes will allow the identification of patients at high risk and the development of new strategies to prevent or delay the renal disease process.
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Affiliation(s)
- Monika Buraczynska
- Professor of Medical Sciences Medical University of Lublin, Laboratory for DNA Analysis and Molecular Diagnostics, Department of Nephrology, Dr K Jaczewskiego 8, 20-954 Lublin, Poland +48 81 7244 716 ; +48 81 7244 716 ;
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Arfa I, Abid A, Nouira S, Elloumi-Zghal H, Malouche D, Mannai I, Zorgati MM, Ben Alaya N, Rebai A, Zouari B, Ben Ammar S, Ben Rayana MC, Hmida S, Blousa-Chabchoub S, Abdelhak S. Lack of association between the angiotensin-converting enzyme gene (I/D) polymorphism and diabetic nephropathy in Tunisian type 2 diabetic patients. J Renin Angiotensin Aldosterone Syst 2008; 9:32-6. [DOI: 10.3317/jraas.2008.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective. The aim of the present study was to investigate whether the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with diabetic nephropathy and type 2 diabetes in the Tunisian population.Design. A case-control study was conducted among 141 unrelated type 2 diabetic patients with (90 patients) or without nephropathy (51 patients) and 103 non-diabetic controls with normal fasting blood glucose. Genotyping was performed using a nested polymerase chain reaction amplification in order to identify correctly heterozygous individuals.Results. The distribution of DD, ID and II genotypes did not significantly differ between type 2 diabetic patients with or without nephropathy (DD: 44%; ID: 46%; II: 10% vs. DD: 41%; ID: 47 %; II: 12%, respectively).There was also no significant statistical difference between the genotype distribution and allele frequencies of the (I/D) polymorphism in all type 2 diabetic subjects compared to non-diabetic controls with normal fasting blood glucose (DD: 43%; ID: 46%; II: 11% vs. DD: 37%; ID: 48% ;II: 15%, respectively).Conclusions. In the present preliminary study, the (I/D) polymorphis within the ACE gene is likely not associated with diabetic nephropathy nor with type 2 diabetes in the Tunisian studied population.
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Affiliation(s)
- Imen Arfa
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | - Sonia Nouira
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia, sonia.abdelhak @pasteur.rns.tn
| | - Houda Elloumi-Zghal
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | - Dhafer Malouche
- Engineering school of statistic and information analysis (LEGI-EPT-ESSAIT), University of 7th November at Carthage Tunis, Tunisia
| | - Imen Mannai
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia, Engineering school of statistic and information analysis (LEGI-EPT-ESSAIT), University of 7th November at Carthage Tunis, Tunisia
| | - Mohamed Majdi Zorgati
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | - Nissaf Ben Alaya
- Laboratory of Epidemiology. Institut Pasteur de Tunis, Tunis, Tunisia
| | | | - Béchir Zouari
- Department of Epidemiology and Statistics, School University of Medicine, Tunis, Tunisia
| | - Slim Ben Ammar
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | - Slama Hmida
- National Center of Blood Transfusion Tunis, Tunisia
| | | | - Sonia Abdelhak
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
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Park HC, Choi SR, Kim BS, Lee TH, Kang BS, Choi KH, Lee HY, Han DS, Ha SK. Polymorphism of the ACE Gene in dialysis patients: overexpression of DD genotype in type 2 diabetic end-stage renal failure patients. Yonsei Med J 2005; 46:779-87. [PMID: 16385653 PMCID: PMC2810591 DOI: 10.3349/ymj.2005.46.6.779] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The angiotensin-converting enzyme (ACE) gene DD homozygote has been suggested to be a significant risk factor for the progression of diabetic nephropathy. We analyzed clinical parameters and ACE genotype distribution between type 2 diabetic patients at the extremes of renal risk, i.e. an end-stage renal failure (ESRF) group (n = 103, group 1) who were on dialysis therapy due to progression of diabetic nephropathy, and a no progression group (n = 88, group 2) who had maintained normal renal function and normoalbuminuria for more than 15 years. There were no significant differences in age, sex, body mass index, HbA1c level, or lipid profiles between the two groups (p > 0.05). Group 1 had a significantly higher prevalence of hypertension [group 1: 82.5% (85/103) vs. group 2: 50.0% (44/88), p < 0.05] and diabetic retinopathy [group 1: 103/103 (100%) vs. group 2: 28/88 (31.8%), p < 0.05] than group 2. Daily urinary albumin excretion was also higher in group 1 than in group 2 [group 1: 2873 +/- 2176 mg/day vs. 12 +/- 7 g/day, p < 0.05]. The frequencies of the DD, ID, and II genotypes of the ACE gene in group 1 and group 2 were 26.2%, 47.6%, and 26.2%, and 7.9%, 57.9%, and 34.2%, respectively. The ACE genotype frequencies between the two groups were significantly different according to a chi-square test with Bonferroni's correction (p = 0.004). The presence of the DD genotype increased the risk of ESRF 4.286-fold compared to the II genotype [odds ratio 4.286, 95% CI 1.60- 11.42, p = 0.005]. The frequency of the D-allele was higher in both male and female patients in group 1 compared to group 2, but reached statistical significance only in males [male, group 1: 50.8% vs. group 2: 35.0%, p = 0.018, female, group 1: 48.8% vs. group 2: 39.5%, p = 0.231]. This study, although limited by sample size, showed that type 2 diabetic ESRF patients more frequently expressed the DD genotype. These findings may substantiate the previously noted relationship between the ACE DD genotype and the progression of diabetic nephropathy in Korean type 2 diabetic patients.
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Affiliation(s)
- Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yongdong Severance Hospital, Yonsei University, Seoul, Korea
| | - So Rae Choi
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yongdong Severance Hospital, Yonsei University, Seoul, Korea
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Severance Hospital, Institute of Kidney Disease, Yonsei University, Seoul, Korea
| | - Tae Hee Lee
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yongdong Severance Hospital, Yonsei University, Seoul, Korea
| | - Byung Seung Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yongdong Severance Hospital, Yonsei University, Seoul, Korea
| | - Kyu Hyun Choi
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Severance Hospital, Institute of Kidney Disease, Yonsei University, Seoul, Korea
| | - Ho Yung Lee
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Severance Hospital, Institute of Kidney Disease, Yonsei University, Seoul, Korea
| | - Dae Suk Han
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Severance Hospital, Institute of Kidney Disease, Yonsei University, Seoul, Korea
| | - Sung-Kyu Ha
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yongdong Severance Hospital, Yonsei University, Seoul, Korea
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Canani LH, Costa LA, Crispim D, Gonçalves Dos Santos K, Roisenberg I, Lisbôa HRK, Sarturi Tres G, Maia AL, Gross JL. The presence of allele D of angiotensin-converting enzyme polymorphism is associated with diabetic nephropathy in patients with less than 10 years duration of Type 2 diabetes. Diabet Med 2005; 22:1167-72. [PMID: 16108844 DOI: 10.1111/j.1464-5491.2005.01622.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To investigate the association between angiotensin-converting enzyme gene I/D polymorphism and diabetic nephropathy (DN) in patients with Type 2 diabetes mellitus (DM) taking into consideration the known duration of DM. METHODS Cross-sectional study with 982 patients categorized according to urinary albumin excretion (UAE) into normoalbuminuria (UAE < 20 microg/min or < 17 mg/l, 24-h timed urine or spot random sterile urine, respectively), incipient DN (UAE 20-199 microg/min or 17-174 mg/l) and overt DN (UAE > 200 microg/min or > 174 mg/l or dialysis). Patients were further grouped regarding presence of the D allele (DD/ID vs. II) and DM duration (< or = 10 years or > 10 years). RESULTS Incipient DN was diagnosed in 17.3% (n = 170), and 20.7% (n = 203) had overt DN (macroalbuminuria, n = 129; dialysis, n = 74). Genotype distribution (DD/ID/II) was similar in patients with incipient (49/92/29) or overt DN (77/89/37) if compared with patients without DN (181/308/120, P = 0.172). In patients with DM < or = 10 years, having the D allele (DD/ID) resulted in an odds ratio (OR) of 2.66 (95% CI: 1.12-6.58, P = 0.015) for incipient DN, and 3.19 (95% CI: 1.18-9.30, P = 0.012) for overt DN. In patients with longer DM duration, the D allele did not increase the risk for incipient (OR 0.68, 95% CI 0.36-1.29, P = 0.206) or overt DN (OR 0.67, 95% CI 0.39-1.17, P = 0.138). CONCLUSION The DD/ID genotypes were associated with incipient or overt DN in patients with DM < or = 10 years.
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Affiliation(s)
- L H Canani
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Jacobsen PK. Preventing end stage renal disease in diabetic patients--genetic aspect (part I). J Renin Angiotensin Aldosterone Syst 2005; 6:1-14. [PMID: 16088846 DOI: 10.3317/jraas.2005.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Diabetic nephropathy is a major cause of diabetes- related morbidity and mortality; however the clinical course of the disease and the renal prognosis is highly variable among individuals. The current review will discuss the genetic influence on the development of end stage renal disease (ESRD) in diabetic patients and potential improvements to the current treatment strategy to slow the loss of kidney function in these patients. In this first part, the growing evidence that glucose-induced activation of the intra-renal and systemic renin-angiotensin systems plays an essential role in processes leading to destruction of renal function is summarised. Genetic variations, especially the angiotensin-converting enzyme (ACE)/ID polymorphisms in the gene coding for ACE, are involved in activation of the renin-angiotensin system and seem to influence the clinical course of diabetic nephropathy during treatment with ACE inhibitors. In addition, this polymorphism may interact with other polymorphisms within the renin-angiotensin system, leading to high risk of ESRD. As new genetic approaches and methods develop, further understanding of diabetic nephropathy will evolve and genotyping will help prevent ESRD in diabetic patients.
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Ng DPK, Tai BC, Koh D, Tan KW, Chia KS. Angiotensin-I converting enzyme insertion/deletion polymorphism and its association with diabetic nephropathy: a meta-analysis of studies reported between 1994 and 2004 and comprising 14,727 subjects. Diabetologia 2005; 48:1008-16. [PMID: 15830182 DOI: 10.1007/s00125-005-1726-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 12/19/2004] [Indexed: 02/03/2023]
Abstract
AIMS/HYPOTHESIS The ACE insertion/deletion polymorphism has been examined for association with diabetic nephropathy over the past decade with conflicting results. To clarify this situation, we conducted a comprehensive meta-analysis encompassing all relevant studies that were published between 1994 and 2004 and investigated this potential genetic association. METHODS A total of 14,727 subjects from 47 studies was included in this meta-analysis. Cases (n=8,663) were type 1 or 2 diabetic subjects with incipient (microalbuminuria) or advanced diabetic nephropathy (proteinuria, chronic renal failure, end-stage renal disease). Control subjects (n=6,064) were predominantly normoalbuminuric. RESULTS No obvious publication bias was detected. Using a minimal-case definition based on incipient diabetic nephropathy, subjects with the II genotype had a 22% lower risk of diabetic nephropathy than carriers of the D allele (pooled odds ratio [OR]=0.78, 95% CI=0.69-0.88). While there was a reduced risk of diabetic nephropathy associated with the II genotype among Caucasians with either type 1 or type 2 diabetes, the association was most marked among type 2 diabetic Asians (Chinese, Japanese, Koreans) (OR=0.65, 95% CI=0. 51-0.83). This OR is significantly different from the OR of 0.90 (95% CI= 0.78-1.04) that was obtained for type 2 diabetic Caucasians (p=0.019). Using a stricter case definition based on advanced diabetic nephropathy, a comparable risk reduction of 24-32% was observed among the three subgroups, although statistical significance was reached only among Asians. CONCLUSIONS/INTERPRETATION The results of our meta-analysis support a genetic association of the ACE Ins/Del polymorphism with diabetic nephropathy. These findings may have implications for the management of diabetic nephropathy using ACE inhibitors especially among type 2 diabetic Asians.
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Affiliation(s)
- D P K Ng
- Department of Community, Occupational and Family Medicine, Faculty of Medicine (MD3), National University of Singapore, 16 Medical Drive, Singapore 117597, Singapore.
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William J, Hogan D, Batlle D. Predicting the development of diabetic nephropathy and its progression. Adv Chronic Kidney Dis 2005; 12:202-11. [PMID: 15822056 DOI: 10.1053/j.ackd.2005.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Diabetes remains the number one cause of end-stage renal disease worldwide. Only about one third of diabetic patients develop nephropathy, and the risk appears to be, in part, genetically determined. In this article, we review clinical and genetic markers for the development and progression of diabetic nephropathy. Microalbuminuria remains the best available predictor of the subsequent development of nephropathy, even though in recent years it has become clear that less than 50% of individuals with type 1 diabetes progress to overt proteinuria over a period of less than 10 years. It is of great interest for early recognition of risk of nephropathy that small elevations in nighttime blood pressure predict microalbuminuria in type 1 diabetes. Genetic markers for diabetic nephropathy have not been conclusively identified. The occurrence of renal events in diabetic patients, however, appears to be influenced by the angiotensin-converting enzyme (ACE) genotype, with a dominant deleterious effect of the D allele (D/D or I/D) versus I/I genotype. Some patients with the DD genotype also appear less susceptible to the renoprotective effects of conventional doses of ACE inhibitors, suggesting that ACE genotyping might be useful in selecting those patients that could benefit from higher doses of ACE inhibitors and more aggressive treatment to prevent or delay disease progression.
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Affiliation(s)
- Josette William
- Division of Nephrology/Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Abstract
Diabetic nephropathy and retinopathy are arguably the two most dreaded complications of diabetes. Together they contribute to serious morbidity and mortality. As they progress to end-stage renal disease and blindness, they impose enormous medical, economic,and social costs on both the patient and the health care system. Because nephropathy and retinopathy are frequently linked in patients,this article reviews their common and individual aspects of pathophysiology, clinical features, and management.
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Affiliation(s)
- Ali Jawa
- Section of Endocrinology, Department of Medicine, Tulane University Health Sciences Center, SL-53, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA
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Jacobsen P, Tarnow L, Carstensen B, Hovind P, Poirier O, Parving HH. Genetic Variation in the Renin-Angiotensin System and Progression of Diabetic Nephropathy. J Am Soc Nephrol 2003; 14:2843-50. [PMID: 14569094 DOI: 10.1097/01.asn.0000092139.19587.51] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT. The impact of polymorphisms in the genes coding for angiotensinogen (M235T), ACE (ID), and angiotensin II type 1 receptor (A1166→C) on decline in GFR and doubling of s-creatinine or development of ESRD in patients with type 1 diabetes and diabetic nephropathy (DN) was tested. From 1985, all patients (n= 169) who had established diabetic nephropathy and were treated with angiotensin-converting enzyme inhibition (ACE-I) were identified consecutively at Steno Diabetes Center. Patients were followed for a median of 6 yr (range, 3 to 15 yr), with nine (range, three to 29) measurements of GFR (51Cr-EDTA). In a Cox proportional hazards model corrected for other risk factors, theDallele (ACE/ID) was associated with time to doubling of s-creatinine/ESRD (rate ratio, 1.81 per allele; 95% confidence interval, 1.09 to 3.03;P= 0.02). A new interaction hypothesis was generated demonstrating that the following variables were associated with accelerated decline in GFR: albuminuria (estimate, 2.12 ml/min per yr per 10-fold increase in albuminuria;P< 0.001), mean BP (estimate, 0.88 ml/min per yr per 10 mmHg;P= 0.02), hemoglobin A1c(estimate, 0.54 min/min per yr per 1%;P= 0.02), and number ofM(M235T)/D(ID)/A(A1166→C) alleles (estimate, 0.45 ml/min per yr per allele;P= 0.049). Number ofM/D/Aalleles also influenced time to doubling of s-creatinine or ESRD. In this study of patients with type 1 diabetes, theDallele of theACE/IDpolymorphism in addition to nongenetic risk factors independently accelerated progression of DN during ACE-I. Interaction between polymorphisms in the renin-angiotensin system also influenced the loss of kidney function. This new genetic interaction model needs to be confirmed in future studies. E-mail: pkjacobsen@dadlnet.dk
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Lindner TH, Mönks D, Wanner C, Berger M. Genetic aspects of diabetic nephropathy. KIDNEY INTERNATIONAL. SUPPLEMENT 2003:S186-91. [PMID: 12694341 DOI: 10.1046/j.1523-1755.63.s84.24.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Diabetic nephropathy from type 2 diabetes mellitus is the most common cause of end-stage renal disease (ESRD) in the United States and in Western Europe. Although patients with overt nephropathy generally experience greater cumulative glycemic exposure, the difference in glycemic control between patients developing nephropathy compared to those who did not, could not be demonstrated. This observation is consistent with the notion that perhaps other factors, in addition to glycemic control, have a bearing on the development of nephropathy. Genetic factors, which specifically increase the susceptibility to nephropathy in patients with diabetes, have been proposed. METHODS A range of linkage and association studies has been performed for revealing the genetic background of diabetic nephropathy. RESULTS Until now, no mutation has been identified which could explain the development of diabetic nephropathy in the majority of diabetic patients. CONCLUSIONS Because of relatively small case numbers of all studies being performed so far, conclusions from those studies are limited. With the development of better technologies for an affordable genome-wide association study using thousands of markers, it might become possible to unravel the genetic causes of diabetic nephropathy.
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Affiliation(s)
- Tom H Lindner
- Department of Medicine, Division of Nephrology, University Clinic, Würzburg, Germany.
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Andersen S, Tarnow L, Cambien F, Rossing P, Juhl TR, Deinum J, Parving HH. Long-term renoprotective effects of losartan in diabetic nephropathy: interaction with ACE insertion/deletion genotype? Diabetes Care 2003; 26:1501-6. [PMID: 12716812 DOI: 10.2337/diacare.26.5.1501] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Several observational follow-up studies have found that the D allele of the insertion (I)/deletion (D) polymorphism of the ACE gene (ACE/ID) is associated with an increased risk of renal function loss, even during ACE inhibition. Therefore, we investigated the long-term effect of the angiotensin II subtype-1 (AT1) receptor antagonist losartan (100 mg o.d.) on kidney function in II and DD type 1 diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS A total of 54 hypertensive type 1 diabetic patients with diabetic nephropathy homozygous for the insertion (n = 26) or the deletion (n = 28) allele were included in the study. After a 4-week washout, the patients received losartan (tablet, 100 mg o.d.) and were followed prospectively with a mean follow-up period of 36 months. Patients and investigators were blinded to ACE genotypes. At baseline, after 2 and 4 months and every 6 months thereafter, glomerular filtration rate (GFR), albuminuria, and 24-h blood pressure were determined. RESULTS At baseline, GFR, albuminuria, and blood pressure were similar in the two genotype groups, II versus DD: mean (SD), 86 (22) vs. 88 (24) ml. min(-1). 1.73 m(-2); median (interquartile range), 1,134 (598-2,023) vs. 1,451 (893-1,766) mg/24 h; and mean (SD), 156/82 (17/9) vs. 153/80 (17/11) mmHg, respectively. GFR decreased similarly in both genotype groups, versus DD, respectively (P = 0.4): geometric mean (95% CI), 2.9 (2.0-4.2) vs. 3.4 (2.3-5.1) ml. min(-1). year(-1). Albuminuria and arterial blood pressure were significantly reduced during the study; no differences were noted between groups. During follow-up, albuminuria was decreased by 75% (95% CI 59-85) and 73% (56-83) in the II and DD groups, respectively (P < 0.01 vs. baseline). Mean systolic and diastolic blood pressures were 139/74 mmHg (14/8) in both genotype groups during the study (P < 0.01 vs. baseline). CONCLUSIONS In contrast to previous observational studies with ACE inhibitors, long-term treatment with losartan has similar beneficial renoprotective effects on progression of diabetic nephropathy in hypertensive type 1 diabetic patients with ACE II and DD genotypes.
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El-Hazmi MA, Warsy AS. Increased frequency of angiotensin-converting enzyme DD genotype in Saudi overweight and obese patients. Ann Saudi Med 2003; 23:24-7. [PMID: 17146217 DOI: 10.5144/0256-4947.2003.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several studies have been carried out to investigate the insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) in obese and normal weight individuals, often with contradictory results in different populatios. In some studies, the DD genotype occurs at a high frequency in obesity, while in others no association has been demonstrated. Since obesity and overweight are of frequent occurrence in the Saudi population, we initiated this study to investigate the I/D polymorphism of ACE in obese, overweight and normal weight Saudis. PATIENTS AND METHODS The study group included 457 Saudi males and females. The height and weight were measured and body mass index (BMI) was calculated. Based on the BMI value, the total study population was classified as normal, overweight and obese. A total of 117 obese (BMI >30 (kg/m(2))), 185 overweight (BMI=25-29.9 (kg/m(2))) and 155 normal weight individuals (BMI< (kg/m (2)) were enrolled. Polymerase chain reaction (PCR) and agarose gel electrophoresis were used to study the ACE polymorphism. For the deletion (D) form, a 190 bp and for the insertion (I) form, 490 bp DNA fragment were obtained on 2% agarose gel electrophoresis. RESULTS The frequency of DD genotype was 76.9% in the obese, and 73.5% in the overweight individuals, compared to 19.66% and 24.86% of the ID genotype in the obese and overweight, respectively. Among the normal weight individuals, the frequency was significantly lower for DD and higher for the ID genotype, i.e., 58.7% for DD and 40% for ID. The allele frequencies in the obese were 0.867 and 0.133 for the D and I alleles, respectively. While in the overweight, the frequencies were 0.859 and 0.141 for these alleles, respectively, compared to 0.787 and 0.213 in the normal weight individuals. CONCLUSIONS The DD genotype and D allele occur at a high frequency in Saudi overweight and obese individuals, and may have some role in fat accumulation by affecting metabolic pathways of fat, thus leading to the development of overweight and obesity.
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Affiliation(s)
- Mohsen Af El-Hazmi
- Department of Medical Biochemistry and the WHO Collaborating Centre, College of Medicine, King Khalid University Hospital and Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia,
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Lansang MC, Hollenberg NK. Renal perfusion and the renal hemodynamic response to blocking the renin system in diabetes: are the forces leading to vasodilation and vasoconstriction linked? Diabetes 2002; 51:2025-8. [PMID: 12086929 DOI: 10.2337/diabetes.51.7.2025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In three groups of subjects, those with type 2 diabetes and nephropathy, those with type 1 diabetes without nephropathy, and healthy volunteers subjected to short-term hyperglycemia, we observed a counterintuitive relationship. In all three groups, baseline renal plasma flow (RPF) was positively correlated with the RPF response to blocking the renin-angiotensin system (RAS). This seems paradoxical in that an opposite result would have been expected if angiotensin-dependent renal vasoconstriction was responsible for the renal vasodilator response to RAS blockade. This suggests a link between the renal vasodilator response, mediated by nitric oxide (NO), and the activation of the intrarenal RAS. The complex interrelationships between hyperglycemia, insulin, NO, and the RAS may result in phenotypes that indicate varying risk of diabetic nephropathy and underlying genetic polymorphisms.
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Affiliation(s)
- M Cecilia Lansang
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Andersen S, Tarnow L, Cambien F, Rossing P, Juhl TR, Deinum J, Parving HH. Renoprotective effects of losartan in diabetic nephropathy: interaction with ACE insertion/deletion genotype? Kidney Int 2002; 62:192-8. [PMID: 12081578 DOI: 10.1046/j.1523-1755.2002.00410.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The beneficial short- and long-term renoprotective effects of angiotensin I-converting enzyme (ACE) inhibition are lower in albuminuric diabetic patients homozygous for the deletion compared to the insertion polymorphism of the ACE gene. In an attempt to overcome this interaction, we evaluated the short-term renoprotective effect in diabetic nephropathy of the angiotensin II receptor antagonist losartan in patients homozygous for the insertion or the deletion allele. METHODS Fifty-four hypertensive type 1 diabetic patients with diabetic nephropathy homozygous for the insertion (I; N = 26) or the deletion (D; N = 28) allele of the ACE/ID polymorphism were included. After four weeks of washout, the patients received losartan 50 mg daily followed by 100 mg in two treatment periods each lasting two months. Patients and investigators were blinded to ACE genotypes. At baseline and in the end of the treatment periods, 24-hour blood pressure, albuminuria and glomerular filtration rate values were determined. RESULTS At baseline, blood pressure, albuminuria and glomerular filtration rate (GFR) values were similar in the two genotype groups [II vs. DD, 1134 (238 to 5302) vs. 1451 (227 to 8129) mg/24 h, median (range); 156/82 (17/9) vs. 153/80 (17/11) mm Hg, mean (SD); and 86 (22) vs. 88 (24) mL/min/1.73 m2, respectively]. Both doses of losartan significantly lowered blood pressure, albuminuria, and GFR (P < 0.05 vs. baseline). Losartan 100 mg was more effective than 50 mg in reducing albuminuria, 51% (95% CI; 40 to 61) versus 33% (23 to 42), respectively (P < 0.01). No differences in the impact of losartan between the II and DD groups were observed: Losartan 100 mg lowered systolic/diastolic blood pressure by 12/6 and 10/4 mm Hg, whereas albuminuria decreased by 55% (35 to 68) and 46% (28 to 61), in the II and DD groups, respectively (P = NS). CONCLUSION Our data suggest that losartan offers similar short-term renoprotective and blood pressure lowering effects in albuminuric hypertensive type 1 diabetic patients with the ACE II and DD genotypes. However, the long-term renoprotective effects remain to be evaluated.
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Affiliation(s)
- Steen Andersen
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Copenhagen, Denmark.
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27
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Elung-Jensen T, Heisterberg J, Kamper AL, Sonne J, Strandgaard S, Larsen NE. High serum enalaprilat in chronic renal failure. J Renin Angiotensin Aldosterone Syst 2001; 2:240-5. [PMID: 11881130 DOI: 10.3317/jraas.2001.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Most angiotensin-converting enzyme (ACE) inhibitors and their metabolites are excreted renally and doses should hence be reduced in renal insufficiency. We studied whether the dosage of enalapril in daily clinical practice is associated with drug accumulation of enalaprilat in chronic renal failure. METHODS Fifty nine out-patients with plasma creatinine >150 micromol/L and chronic antihypertensive treatment with enalapril were investigated, in a cross-sectional design. RESULTS Median glomerular filtration rate (GFR) was 23(range 6-60) ml/minute/1.73 m2. The daily dose of enalapril was 10 (2.5-20) mg and the trough serum concentration of enalaprilat was 31.8 (<2.5-584.7)ng/ml. Ninety percent of the patients had higher serum concentrations of enalaprilat than has been reported in subjects with normal kidney function, and a marked elevation of serum enalaprilat was observed in patients with GFR <30 ml/minute. All but three patients had serum ACE activity below the reference range. The ACE genotype did not influence the results. Additional pharmacokinetic studies were done in nine patients in whom GFR was 23 (10-42)ml/minute/1.73 m2. The median clearance of enalaprilat was 28 (16-68) ml/minute and correlated linearly with GFR (r=0.86, p=0.003). Intra-subject day-to-day variation in trough concentrations was 19.7%. CONCLUSION Patients with chronic renal failure given small or moderately high doses of enalapril may thus have markedly elevated levels of serum enalaprilat. Whether this affords extra renoprotection, or on the contrary may inappropriately impair renal function, is not known, and should be investigated in prospective, controlled studies.
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Affiliation(s)
- T Elung-Jensen
- Department of Nephrology, Herlev Hospital, Copenhagen, Denmark.
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28
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Fava S, Azzopardi J, Ellard S, Hattersley AT. ACE gene polymorphism as a prognostic indicator in patients with type 2 diabetes and established renal disease. Diabetes Care 2001; 24:2115-20. [PMID: 11723093 DOI: 10.2337/diacare.24.12.2115] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether the DD genotype is a predictor of mortality and of the decline in renal function in patients with type 2 diabetes and established nephropathy. RESEARCH DESIGN AND METHODS A total of 56 such patients of Maltese Caucasian descent were recruited, and their ACE genotype was determined. Serum creatinine was estimated approximately every 4 months. The glomerular filtration rate (GFR) was calculated according to the Cockroft-Gault formula, and rate of change was determined by regression analysis. RESULTS The rate of change in calculated GFR was -7.76 ml.min(-1).year(-1) in those with the DD genotype (n = 31) and -1.17 ml. min(-1). h(-1) in those with the ID or II genotype (n = 25) (P < 0.01). The 3-year mortality was 45.2% in the DD group compared with 20.0% in the ID/II group (P < 0.05). CONCLUSIONS The DD genotype of the ACE gene polymorphism is associated with a more rapid decline in renal function and higher mortality in type 2 diabetic patients with established nephropathy.
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Affiliation(s)
- S Fava
- Diabetes Clinic, St. Luke's Hospital, Guardamangia, Malta.
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29
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Affiliation(s)
- H H Parving
- Steno Diabetes Center, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark.
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30
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Azar ST, Zalloua PA, Medlej R, Halabi G. The DD genotype of the ACE gene polymorphism is associated with diabetic nephropathy in the type-1 diabetics. Endocr Res 2001; 27:99-108. [PMID: 11428725 DOI: 10.1081/erc-100107173] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Genetic factors are involved in the development of diabetic nephropathy in type-1 diabetes. We are examining the association of the angiotensin-converting enzyme (ACE), insertion/deletion (I/D) polymorphism with the presence of diabetic nephropathy in type-1 diabetic patients. 52 type-1 diabetic patients with diabetic nephropathy (30 with either microalbuminuria or macroalbuminuria and 22 with end stage renal disease on dialysis) were compared with 10 type-1 diabetic patients with normoalbuminuria and duration of disease longer than 15 years and 27 non-diabetic healthy subjects. We found that the D-allele frequency was higher in patients with nephropathy than in the healthy and normoalbuminuric controls. There was an association in the DD polymorphism of the ACE gene with patients with diabetic nephropathy and not with the control subjects. We conclude that the DD genotype of ACE gene polymorphism is associated with diabetic nephropathy in patients with type-1 diabetes mellitus.
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Affiliation(s)
- S T Azar
- The Chronic Center for Diabetes, Beirut
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31
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Taal MW. Angiotensin-converting enzyme gene polymorphisms in renal disease: clinically relevant? Curr Opin Nephrol Hypertens 2000; 9:651-7. [PMID: 11128428 DOI: 10.1097/00041552-200011000-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most recent studies of the effect of polymorphisms of the angiotensin-converting enzyme gene on the pathogenesis of renal diseases and the response to treatment with angiotensin-converting enzyme inhibitors continue to produce conflicting results. Large prospective studies are required before angiotensin-converting enzyme genotyping will provide information that will assist in the assessment of prognosis and response to angiotensin-converting enzyme inhibitor treatment in individual patients. Until such studies are performed, all patients with chronic renal disease, regardless of angiotensin-converting enzyme genotype, should be considered candidates for angiotensin-converting enzyme inhibitor therapy.
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Affiliation(s)
- M W Taal
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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32
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33
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Khan MA, Collins AJ, Keane WF. Diabetes in the elderly population. ADVANCES IN RENAL REPLACEMENT THERAPY 2000; 7:32-51. [PMID: 10672916 DOI: 10.1016/s1073-4449(00)70004-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Type 2 diabetes mellitus has emerged as an important condition of older patients in which both microvascular and macrovascular complications are a common cause of morbidity and mortality. In contrast to type 1 diabetes mellitus, this endocrinopathy is clustered in minority populations and has both strong genetic and environmental factors that influence disease manifestation. A number of physiological alterations of glucose metabolism including hepatic overproduction of glucose, and reduced glucose utilization by peripheral tissues as a result of insulin resistance contribute to the development of the metabolic manifestations of this disease. Ultimately, pancreatic failure and reduced insulin secretion lead to hyperglycemia and the diabetic state. Frequently, many of these metabolic manifestations, or what has been termed Syndrome X, antecede the development of overt diabetes by many years. This syndrome is manifest clinically by such cardiovascular risk factors as hypertension, dyslipidemia, and coagulation abnormalities. This abnormal metabolic milieu contributes to the high prevalence of macrovascular complications including coronary artery disease as well as more generalized atherosclerosis. Microvascular complications have only more recently been recognized as an important and frequent complication of type 2 diabetes. Among the elderly and minority populations, this has become the single most important cause of end-stage renal failure that necessitates renal replacement therapies. The outcome for these patients on hemodialysis, the modality most frequently selected, is poor, with the majority of these patients dying of cardiovascular causes. Unfortunately, interventional strategies to reduce or prevent the microvascular and macrovascular complications have only recently received the needed attention and will require considerable effort and resources to improve the clinical outcomes and life expectancies for these patients.
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Affiliation(s)
- M A Khan
- Department of Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, USA
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34
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Stratta P, Canavese C, Ciccone G, Barolo S, Dall'Omo AM, Fasano ME, Mazzola G, Berutti S, Fop F, Curtoni ES, Piccoli G. Angiotensin I-converting enzyme genotype significantly affects progression of IgA glomerulonephritis in an italian population. Am J Kidney Dis 1999; 33:1071-9. [PMID: 10352195 DOI: 10.1016/s0272-6386(99)70144-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To evaluate the role of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism in the progression of immunoglobulin A glomerulonephritis (IgA-GN), genotype distribution in 81 biopsy-proven cases of IgA-GN was studied. A logistic regression model showed that the risk for homozygous DD was not significantly elevated in patients with IgA-GN compared with healthy subjects (odds ratio = 1.16; confidence interval [CI], 0.4 to 3.3). However, the 5-year (78% v 90%) and 10-year (52% v 82%) renal survival rates for 47 patients with serum creatine (Cr) levels of 1.5 mg/dL or less at biopsy was significantly less in DD patients (n = 18; chi2 = 5.41; P = 0.02). The hazard ratio (HR) for DD (multivariate analysis from Cox proportional model after adjustment for known factors of progression, such as hypertension [HPT] and proteinuria [PTO]) was 3.07 (CI, 1.1 to 9.4). The HR for heavy PTO was 6.1 (CI, 1.9 to 19). The association of DD genotype with progression was even more striking when patients with other risk factors (heavy proteinuria) were excluded, as shown by DD-related risk in the absence (HR = 3.6; CI, 1.1 to 12) and presence (HR = 2; CI, 0.4 to 10) of PTO. The risk ratio was further increased by the coexistence of DD + PTO (HR = 9.16; CI, 1.8 to 15.7). Furthermore, in a cross-sectional study among patients with IgA-GN, a logistic regression model showed that the risk for homozygous DD was greater, although not at a statistically significant level in the end-stage renal failure subgroup compared with the normal renal function subgroup (odds ratio = 3.16; CI, 0.7 to 13.7) after adjustment by sex, age at biopsy, HPT, PTO, and therapy. Last, DD was significantly more frequent in those patients who started hemodialysis at an earlier age (chi2 for trend = 6.81; P = 0.009). Our study further supports that ACE genotype is a risk factor not for the development, but for the worsening of IgA-GN clinical course. However, on the basis of current knowledge, we cannot exclude that I/D polymorphism may simply serve as a prognostic marker, eventually linked with other discrete loci involved in the progression of renal damage.
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Affiliation(s)
- P Stratta
- Epidemiology Unit of Cancer, Service of Transplant Immunology of the University of Torino, Torino, Italy.
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35
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Abstract
End-stage renal failure (ESRF) in diabetic patients, mostly type 2, has become the most frequent cause of renal replacement therapy in western Europe. The majority of patients with type 2 diabetes and renal failure suffer from diabetic glomerulosclerosis, but nondiabetic renal disease and atypical presentations, e.g. as irreversible acute renal failure or ischaemic nephropathy, play an increasingly important role. Known risk factors for the onset of diabetic nephropathy include (1) genetic predisposition (indicated by a history of hypertension and cardiovascular events in first-degree relatives), (2) quality of glycaemic control, (3) level of blood pressure, and (4) smoking. At the time when type 2 diabetes is diagnosed, an abnormal blood pressure profile is found in approximately 80%. In patients with established diabetic nephropathy, hypertension is the most important factor which promotes progression, and this is susceptible to intervention. Although less data are available for type 2 diabetes (compared with type 1 diabetes), ACE inhibitors appear to be the antihypertensive agent of first choice, but monotherapy is rarely sufficient to achieve the blood pressure goal. Although, at least in principle, diabetic nephropathy is a preventable condition, currently only a minority of type 2 diabetic patients in western Europe receives adequate medical treatment to prevent onset or progression of diabetic nephropathy. Consequently, novel approaches to patient management and interdisciplinary interaction are necessary to fulfil the postulate of the St Vincent declaration concerning prevention of diabetic complications.
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Affiliation(s)
- E Ritz
- Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany
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36
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Ismail N, Becker B, Strzelczyk P, Ritz E. Renal disease and hypertension in non-insulin-dependent diabetes mellitus. Kidney Int 1999; 55:1-28. [PMID: 9893112 DOI: 10.1046/j.1523-1755.1999.00232.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recent epidemiologic data demonstrate a dramatic increase in the incidence of end-stage renal disease (ESRD) in patients with non-insulin-dependent diabetes mellitus (NIDDM), thus dispelling the mistaken belief that renal prognosis is benign in NIDDM. Currently, the leading cause of ESRD in the United States, Japan, and in most industrialized Europe is NIDDM, accounting for nearly 90% of all cases of diabetes. In addition to profound economic costs, patients with NIDDM and diabetic nephropathy have a dramatically increased morbidity and premature mortality. NIDDM-related nephropathy varies widely among racial and ethnic groups, genders and lifestyles; and gender may interact with race to affect the disease progression. While the course of insulin-dependent diabetes mellitus (IDDM) progresses through well-defined stages, the natural history of NIDDM is less well characterized. NIDDM patients with coronary heart disease have a higher urinary albumin excretion rate at the time of diagnosis and follow-up. This greater risk may also be associated with hypertension and hyperlipidemia, and genes involved in blood pressure are obvious candidate genes for diabetic nephropathy. Hyperglycemia appears to be an important factor in the development of proteinuria in NIDDM, but its role and the influence of diet are not yet clear. Tobacco smoking can also be deleterious to the diabetic patient, and is also associated with disease progression. Maintaining euglycemia, stopping smoking and controlling blood pressure may prevent or slow the progression of NIDDM-related nephropathy and reduce extrarenal injury. Treatment recommendations include early screening for hyperlipidemia, appropriate exercise and a healthy diet. Cornerstones of management should also include: (1) educating the medical community and more widely disseminating data supporting the value of early treatment of microalbuminuria; (2) developing a comprehensive, multidisciplinary team approach that involves physicians, nurses, diabetes educators and behavioral therapists; and (3) intensifying research in this field.
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Affiliation(s)
- N Ismail
- Department of Internal Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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37
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Gene polymorphism and chronic renal diseases. Clin Exp Nephrol 1998. [DOI: 10.1007/bf02480460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Jardine AG, Padmanabhan N, Connell JM. Angiotensin converting enzyme gene polymorphisms and renal disease. Curr Opin Nephrol Hypertens 1998; 7:259-64. [PMID: 9617555 DOI: 10.1097/00041552-199805000-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the past year there has been a profusion of reports identifying a possible association between the insertion/deletion polymorphism of the angiotensin converting enzyme and renal diseases. Rather than clarifying the situation, it has become more difficult to interpret its significance owing to small sample sizes and concerns over methodology; hence, studies are frequently contradictory. Despite these concerns there is evidence for a role of this polymorphism in progressive renal disease. This review summarizes the major studies in this field and suggests future strategies that might be employed to identify useful genetic markers in nephrology, for which the angiotensin converting enzyme polymorphism has acted as an important paradigm.
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Affiliation(s)
- A G Jardine
- Department of Medicine and Therapeutics, University of Glasgow, UK.
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