In this study, variations in the frequencies of the apo epsilon4 allele and the apo E3/E4 and E4/E4 genotypes were found in patients with NIDDM, GN and ADPKD. This result may be a consequence of the effects of the apo epsilon4 and epsilon2 alleles on P-cholesterol and remnant lipoprotein levels. The decreased frequency of apo E3/E4 found in patients with NIDDM may be explained by the fact that the epsilon4 allele gives renoprotection against diabetic nephropathy by lowering plasma remnant lipoprotein levels. Conversely, there may be an association between the apo E3/E4 genotype and the epsilon4 allele in patients with ADPKD, due to the effect of the epsilon4 allele in elevating P-cholesterol levels. The most plausible explanation for the absence of the apo E4/E4 genotype and the lower prevalence of the epsilon4 allele in patients with GN, which is known to result in a higher P-cholesterol compared to the epsilon2 and epsilon3 alleles, ought to be an increase in cardiovascular morbidity, which is known to be associated with a higher P-cholesterol level.

There is increasing evidence that lipoproteins are involved in the progression of kidney diseases and in the deterioration of kidney transplant function, although the exact mechanism is still not known. Common polymorphisms of apolipoprotein E genotype associate with the variability of lipoprotein levels and composition. We have, therefore, determined the apolipoprotein E genotype in a group of 112 renal transplant patients, of whom 27 had had an episode of acute vascular rejection, while 85 had not. We found no difference in apolipoprotein E genotype distribution or in relative allele frequency in the vascular rejection group as compared with the group without vascular rejection. The apolipoprotein E genotype distribution in the transplant group was also compared with that in a group of 407 healthy Swedish individuals. The E3/E4 genotype occurred with a significantly increased frequency in the transplant group: 38.3 versus 16% in the control group (p < 0.001). The prevalence of individuals carrying the Ε4 allele among the transplant group was also significantly higher (44%) as compared with the control group (30%; p < 0.01). This increase was entirely due to the predominant increase of E3/E4, as the E4/E4 genotype was less frequent in transplant recipients than in normal controls (3.5 vs. 10.6%; p < 0.05). The relative frequencies of Ε2 (0.044), Ε3 (0.716), and Ε4 (0.238) alleles in the renal transplant group were not different from those of normal controls (0.078, 0.718, and 0.202, respectively). With regard to the prevalence of E4/E4 in the two groups, the lack of difference in the relative frequency of the Ε4 allele must be interpreted with caution. The results thus suggest that the E3/E4 genotype may be associated with the progression of kidney disease leading to renal insufficiency. However, the apolipoprotein E genotype does not seem to influence the risk of vascular rejection among transplant recipients.

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Background: The indications for percutaneous transluminal renal angioplasty (PTRA) in renovascular disease, as well as its benefits, remain a matter of debate. The aim of this study was to evaluate the outcome of angioplasty and to identify risk factors associated with less successful outcomes in patients with atheromatous renal artery stenosis and renal failure of varying degrees. Methods: The results of PTRA were analyzed retrospectively in 144 patients with serum creatinine levels of >130 µmol/l. Patients were divided into 5 groups according to their indication for angioplasty: (1) deteriorating renal function; (2) accelerating hypertension; (3) a combination of 1 and 2; (4) peripheral vascular disease, and (5) miscellaneous conditions. Results: The baseline mean (± SD) systolic and diastolic blood pressures of the entire group were lowered from 180 ± 32 and 95 ± 16 mm Hg to 162 ± 23 and 86 ± 12 mm Hg, respectively (p < 0.0005), 12 months after angioplasty. The blood pressure level was unaffected by angioplasty in patients with claudication. The mean number of antihypertensive drugs was reduced in the group with accelerating hypertension from 2.9 ± 0.8 to 2.4 ± 1.2 (p = 0.019), and in the group with unilateral renal artery stenosis and two kidneys from 2.4 ± 1.0 to 1.8 ± 1.1 (p = 0.002), 12 months after PTRA. Glomerular filtration rate at 3-month follow-up had increased from 23 ± 11 to 27 ± 14 ml/min/1.73 m² (p = 0.021) in group 1, from 25 ± 11 to 28 ± 14 ml/min/1.73 m² (p = 0.031) in the combined group of patients consisting of groups 1 and 3, and from 32 ± 13 to 35 ± 14 ml/min/1.73 m² (p = 0.019) in the group with unilateral renal artery stenosis. No statistically significant difference was found in any of these 3 groups 1 year after angioplasty. The first patient group had an increased prevalence of cardiovascular disease, aortic aneurysm, carotid occlusive disease, and peripheral vascular disease compared to the other patient groups (p < 0.05). Patients with baseline creatinine levels of >300 µmol/l had a lower survival rate at 12, 60, and 120 months after PTRA than patients with serum creatinine levels of <300 µmol/l (p < 0.005). Survival was also lower in patients with bilateral renal artery stenosis and those with a single kidney, compared to patients with a unilateral stenosis at both 5 and 10 years after PTRA (p < 0.05). Regression analysis of predictor variables of mortality rate showed that the relative risk (RR) associated with increased serum creatinine was 4.7 (CI 2.0–11.0; p < 0.0005). The RR for older patients was 1.1 (CI 1.0–1.2; p = 0.008), and the RR for former smokers was 6.0 (CI 1.6–24.0; p = 0.009). Conclusion: The results of the present study indicate that glomerular filtration can be improved in patients who primarily undergo angioplasty to rescue renal function. Renal function with creatinine levels of >300 µmol/l was associated with a lower survival rate. It is, therefore, possible that patients selected after a thorough evaluation of their renal funct...

The results of the present study indicate that the decline of renal function in patients with diabetes type 2 may not be associated with levels of plasma cholesterol, but with triglyceride lipoproteins, considered remnant lipoproteins. Any association between cholesterol and apolipoprotein epsilon4 allele with progression in ADPKD may not necessarily be straightforward since this disease is influenced by other genetic and unidentified factors.