Deletion polymorphism of the angiotensin converting enzyme gene predicts persistent proteinuria in Henoch-Schönlein purpura nephritis.
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.


METHODS
Cross 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).


METHODS
ACE genotypes, systemic blood pressures, urine protein excretion rate, haematuria, creatinine clearance, serum ACE activities.


RESULTS
The 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.


CONCLUSIONS
The 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.
Yoshioka
T
T
Department of Pharmacology, Tokyo Women's Medical University, School of Medicine, Japan. yoshioka@research.twmc.ac.jp
Xu
Y X
YX
Yoshida
H
H
Shiraga
H
H
Muraki
T
T
Ito
K
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D017353:Gene Deletion; D005838:Genotype; D005921:Glomerulonephritis / Q000201:enzymology / Q000209:etiology / Q000235:genetics*; D005922:Glomerulonephritis, IGA / Q000201:enzymology / Q000235:genetics; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000201:enzymology / Q000235:genetics*; D008297:Male; D007703:Peptidyl-Dipeptidase A / Q000097:blood / Q000235:genetics*; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology / Q000235:genetics*
D007703:Peptidyl-Dipeptidase A