[Genetic determinants of acute renal damage risk and prognosis: a systematic review]

Abstract

Introduction: Acute renal damage (ARD) is a frequent syndrome in hospitalized patients. It is well accepted that ARD susceptibility and outcome are related to environmental risk factors and to the patient premorbid status. Recently, host factors have also been recognized as important in ARD predisposition and evolution.

Objective: To analyze genetic influences related to the risk and severity of ARD.

Data source: MEDLINE search.

Selection of studies: articles published in English or Spanish between 1/1/1995 and 31/5/2011, analyzing the association between genic polymorphisms and (a) ARD susceptibility in patients versus healthy controls or within groups of patients; or (b) ARD severity.

Exclusion criteria: studies published only in abstract form, case reports or including patients less than 16 years of age, on chronic dialysis or having received a renal transplant.

Data extraction: at least one investigator analyzed each manuscript and collected the information using a predefined form.

Results: We identified 12 relevant studies that included 4835 patients. Eleven genes showed polymorphisms related to ARD susceptibility or severity. They were related to cardiovascular regulation (ACE I/D, eNOS, FNMT and COMT), inflammatory response (TNFα, IL10, IL6, HIP-1α, EPO), oxidative stress (NAPH oxidase) and lipid metabolism (APO E). Only APO E, ACE and AT1 receptor have been analyzed in more than one study.

Conclusion: ARD susceptibility and severity is influenced by genetic factors, which are multiple and involve different physiopathological mechanisms.