Angiotensin I-converting enzyme gene polymorphism in non-diabetic renal disease

Nephrol Dial Transplant. 2000 Apr;15(4):481-6. doi: 10.1093/ndt/15.4.481.

Abstract

Background: The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene determines the concentration of ACE in serum and local tissues. The role of this polymorphism in progressive chronic renal disease is still not fully clear.

Methods: We analysed the impact of the D/D polymorphism on the rate of decline in renal function in patients with non-diabetic, chronic progressive renal insufficiency. Seventy non-diabetic patients, aged 21-69 years at baseline, with moderately advanced renal insufficiency due to primary chronic renal disease were followed for an average of 3 years with repeated measurements of their glomerular filtration rate (GFR). Their mean GFR at baseline was 41 ml/min/1.73 m(2) body surface area (BSA). The polymerase chain reaction (PCR) amplification method was used to detect the I/D polymorphism of the ACE gene. GFR was measured as the clearance of (51)Cr-EDTA and the individual rate of progression was calculated using linear regression.

Results: The distributions of the genotypes were: D/D 30%, I/D 49%, and I/I 21%. The rates of progression in the three ACE genotype groups were an annual decline in renal function of -4.2 (SD 4.6) ml/minx1.73 m(2) BSA in the D/D group, -2.7 (SD 3. 4) in the I/D group and -1.7 (SD 3.4) in the I/I group (ANOVA P=0. 12). In patients with proteinuria below 3.5 g/24 h, the D/D group had a significantly higher rate of progression than patients with the I allele. The same was found in a separate analysis when only patients with normal apoliprotein B (below 155 mg/dl) levels were analysed. Furthermore, the D/D genotype was a significant predictor of a more rapid decline in renal function in male, but not female, patients.

Conclusion: The results in this study in non-diabetic patients with chronic renal disease indicate that the presence of the D allele in the ACE genotype may be of particular importance as a predictor of a high rate of progression in male patients who otherwise do not have a major burden of documented and important prognostic factors for progressive renal insufficiency.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Apolipoproteins B / blood
  • DNA / analysis*
  • DNA Primers / chemistry
  • DNA Transposable Elements / genetics
  • Diabetes Mellitus
  • Disease Progression
  • Female
  • Gene Deletion
  • Genetic Markers
  • Genotype
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / enzymology*
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / genetics
  • Male
  • Middle Aged
  • Peptidyl-Dipeptidase A / blood
  • Peptidyl-Dipeptidase A / genetics*
  • Polymerase Chain Reaction
  • Polymorphism, Genetic*
  • Prognosis

Substances

  • Apolipoproteins B
  • DNA Primers
  • DNA Transposable Elements
  • Genetic Markers
  • DNA
  • Peptidyl-Dipeptidase A