Abstract
Purpose
To investigate the association of angiotensin-converting enzyme (ACE) gene insertion/deletion
(I/D) polymorphism and other risk factors with renal scarring in patients with posterior
urethral valves (PUV).
Materials and methods
Forty consecutive patients from North-west India were treated for PUV in 1997–2004.
The patients were divided into group 1 (no renal scarring, n=12) and group 2 (renal scars present, n=28) based on dimercato-succinic acid scans. ACE I/D polymorphism was determined by
polymerase chain reaction in PUV patients and unrelated healthy controls (n=100).
Results
Mean age at presentation was 23.7±37.2 months and mean follow up was 4.8±1.5 years. Preoperative mean serum creatinine levels for group 1 (non-scarred) and
group 2 (scarred) were 1.1±1.6 mg/dl and 1.7±1.6 mg/dl, respectively. One year after treatment, the serum creatinine levels had decreased
to 0.6±0.1 mg/dl and 0.8±0.3 mg/dl in group 1 and group 2, respectively. ACE genotype distribution in children
with PUV was no different from that of controls. The occurrence of D allele was significantly
(p=0.04) higher in patients of group 2. Multivariate logistic regression analysis showed
that D allele had a significant impact on renal scar formation, introducing a 4.6-fold
risk (odds ratio 4.6, 95% confidence interval 1.03–20.38, p=0.04). A highly significant correlation between the occurrence of renal scarring and
presence of breakthrough urinary tract infection (odds ratio=7.5, 95% confidence interval 1.60–35.07, p=0.006) and serum creatinine at follow up (odds ratio=0.6, 95% confidence interval 0.47–0.81, p=0.03) was observed. The mean values for glomerular filtration rate (GFR) after 1 year
of treatment (p=0.006) and at follow up (p=0.027) were significantly different between the patients with II genotype and ID/DD
genotype. Hypertension was observed in 13 patients and proteinuria in nine patients
with no significant difference between the patients having II/I D/DD genotypes.
Conclusion
The presence of D allele is associated with progression of renal scarring and reduced
GFR in PUV patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long term outcome of boys with posterior urethral valves.Br J Urol. 1988; 62: 59
- Management of congenital posterior urethral valves.Br J Urol. 1985; 57: 71
- Posterior urethral valves, a cohort with a 20-year follow up.J Urol. 1994; 151: 275
- Association studies, ACE polymorphism and renal disease.Nephrol Dial Transplant. 1996; 11: 757-759
- Impact of ACE I/D gene polymorphism on congenital renal malformations.Pediatr Nephrol. 2001; 16: 356
- Deletion polymorphism in the gene for angiotensin converting enzyme is a potential risk factor for myocardial infarction.Nature. 1992; 359: 641
- Angiotensin converting enzyme gene polymorphism in Asian Indian children with congenital uropathies.J Urol. 2004; 171: 838-840
- Medical versus surgical treatment of primary vesicoureteral reflux, a prospective international reflux study in children.J Urol. 1981; 125: 277
- Evaluation of height/plasma creatinine formula in the measurement of glomerular filtration rate.Arch Dis Child. 1982; 57: 611-615
- Report of the Second Task Force on blood pressure control in children – 1987. Task Force on Blood Pressure Control in Children. The National Heart, Lung, and Blood Institute, Bethesda, Maryland.Pediatrics. 1987; 79: 1-25
- Exclusion of a man charge with murder by DNA fingerprinting.Forensic Sci Int. 1987; 35: 145-148
- Deletion polymorphism in Ace gene associated with present history of myocardial infarction.Lancet. 1993; 341: 991
- Association of a polymorphism of the angiotensin I converting enzyme gene with essential hypertension.Biochem Biophys Res Commun. 1992; 184: 9
- Factors affecting renal scarring in posterior urethral valves.J Pediatr Urol. 2006; 2: 569-574
- Angiotensin converting enzyme genotype distribution in familial vesicoureteric reflux.Pediatr Surg Int. 2001; 17: 308
- Angiotensin converting enzyme gene insertion/deletion polymorphism and renal damage in childhood uropathies.Pediatr Int. 2000; 42: 348
- Potential risk factors associated with progressive renal damage in childhood urological diseases: the role of angiotensin converting enzyme gene polymorphism.J Urol. 1997; 158: 1308
- Implications of certain genetic polymorphism.Am J Kidney Dis. 1999; 34: 140
- ACE I/D gene polymorphism predict renal damage in congenital uropathies.Pediatr Nephrol. 1999; 13: 524
- ACE and AT1 receptor gene polymorphisms and renal scarring in urinary bladder dysfunction.Pediatr Nephrol. 2004; 18: 858
- Angiotensin converting enzyme and angiotensin type 2 receptor gene genotype distribution in Italian children with congenital uropathies.Pediatr Res. 2004; 56: 988
- Low rennin-angiotensin system activity gene polymorphism and dysplasia associated with posterior urethral valves.J Urol. 2005; 174: 713
Article info
Publication history
Published online: February 02, 2007
Accepted:
October 26,
2006
Received:
August 8,
2006
Identification
Copyright
© 2006 Published by Elsevier Inc.
