Deletion polymorphism of the angiotensin converting enzyme gene predicts persistent proteinuria in Henoch-Schönlein purpura nephritis
a Department of
Pharmacology, Tokyo Women's Medical University, School of Medicine,
8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan, b Department of Pediatric Nephrology, Kidney
Center, Tokyo Women's Medical University, c Department of Internal
Medicine II, Jikei Medical School, Tokyo, Japan
Correspondence to: Dr Yoshioka. email: yoshioka{at}research.twmc.ac.jp
Accepted 8 May 1998
OBJECTIVE
To study the influence of
deletion/insertion polymorphism in the 16th intron of the angiotensin
converting enzyme (ACE) gene on clinical manifestations of
Henoch-Schönlein purpura nephritis.
STUDY DESIGNCross sectional study. ACE gene
polymorphism was determined in patients (4-15 years old at onset) with
Henoch-Schönlein purpura nephritis (n = 40) and compared with that
in patients with IgA nephropathy (n = 79).
MAIN OUTCOME MEASURESACE genotypes, systemic
blood pressures, urine protein excretion rate, haematuria, creatinine
clearance, serum ACE activities.
RESULTSThe initial clinical manifestations of
both Henoch-Schönlein purpura nephritis and IgA nephropathy were no
different among homozygotes for insertion (II) and deletion (DD), and
heterozygotes (ID) for the ACE gene. In patients with
Henoch-Schönlein purpura nephritis, the incidence of moderate to
heavy proteinuria at four and eight years after onset was more than
five times higher in the DD genotype than in the II or ID genotypes. No
such trend was seen in patients with IgA nephropathy. The number of
patients with Henoch-Schönlein purpura nephritis in whom proteinuria
resolved at four and eight years after onset was significantly lower in the DD genotype compared with the II genotype, whereas no differences were detected among the three different genotypes in patients with IgA
nephropathy. Plasma ACE activities in patients with the DD genotype
were significantly higher than in those with non-DD genotypes.
CONCLUSIONSThe ACE DD genotype predicts
persistent proteinuria in Henoch-Schönlein purpura nephritis. The
proteinuria might be related to a defective angiotensin system which is
genetically determined by the D/I polymorphism.
© 1998 by Archives of Disease in Childhood
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