Renin-angiotensin system polymorphisms and renal scarring

Area of Science:

• Nephrology
• Genetics
• Pediatrics

Background:

• Vesicoureteral reflux (VUR) can lead to reflux nephropathy (RN) and renal scarring.
• The renin-angiotensin-aldosterone system (RAS) plays a role in renal function and disease.
• Polymorphisms in RAS genes have been investigated as potential risk factors for RN.

Purpose of the Study:

• To investigate the association between DNA polymorphisms in RAS genes and the development of renal scarring in patients with VUR.
• To determine if specific genotypes, such as the ACE DD genotype, are linked to adverse renal prognosis in RN.

Main Methods:

• Genotyping of ACE I/D, AT1 A1166C, AT2 A3123C, and AGT M235T polymorphisms using polymerase chain reaction.
• Measurement of serum ACE levels.
• Recruitment of 246 patients with VUR, RN, chronic renal failure due to RN, and a control group.

Main Results:

• No statistically significant differences in RAS polymorphism distribution were found between patient groups.
• The ACE D allele was associated with higher serum ACE levels.
• No association was observed between ACE I/D polymorphism and hypertension, proteinuria, VUR grade, or laterality.
• Patients with the ACE DD genotype showed a lower incidence of febrile urinary tract infection as the initial symptom.

Conclusions:

• Genetic polymorphisms of RAS components are not independent prognostic indicators of renal scarring in patients with VUR.
• The ACE DD genotype may be associated with a milder presentation of VUR/RN.
• Further research is needed to elucidate the role of RAS in VUR and RN pathogenesis.