Angiotensin gene polymorphism as a determinant of posttransplantation renal dysfunction and hypertension.
BACKGROUND
Polymorphism of the genes associated with angiotensin, including angiotensin-converting enzyme (ACE), angiotensinogen (AGT), and the type 1 (AT1) and type 2 (AT2) angiotensin II receptors, has been implicated in the pathophysiology of hypertension, ischemic heart disease, and progression of chronic renal disease.


METHODS
We investigated the impact of the ACE, AGT, AT1, and AT2 genotypes on renal allograft function in 148 patients (77 men, 71 women) who underwent transplantation over a 5-year period. Patients were genotyped using polymerase chain reaction sequence-specific primers and polymerase chain reaction followed by restriction fragment length polymorphism analysis.


RESULTS
ACE (D) and AGT (A/A) genotypes were associated with poorer chronic renal transplant function and more rapid chronic progression, defined as an increase of serum creatinine level with time. In addition, mean diastolic blood pressure at 3 years was significantly (P<0.02) correlated with C gene dose of AT1 (A-->C, 1166), with levels of 79+/-10 mmHg, 82+/-8.6 mmHg, and 95+/-8.3 mmHg for the A/A, A/C, and C/C genotypes, respectively. An apparent AT2 homozygote disadvantage could be an epiphenomenon because AT2 maps to the X chromosome, and males are homozygous for just one of the AT2 alleles (A/- or G/-).


CONCLUSIONS
Pretransplantation testing of the ACE, AGT, and AT1 genotypes may assist clinicians in identifying patients at risk for chronic renal transplant dysfunction and hypertension.
Abdi
R
R
Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. rabdi@rics.bwh.harvard.edu
Tran
T B
TB
Zee
R
R
Brenner
B M
BM
Milford
E L
EL
D000328:Adult; D000368:Aged; D000809:Angiotensins / Q000235:genetics*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000235:genetics* / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000209:etiology* / Q000235:genetics*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D012307:Risk Factors; D014019:Tissue Donors
D000809:Angiotensins