ACE gene insertion/deletion polymorphism and renal scarring in children with urinary tract infections

Abstract

Urinary tract infection is a common bacterial disease that presents during childhood and may lead to renal scarring. Several studies have shown a strong association between the angiotensin converting enzyme (ACE) deletion polymorphism and renal scarring in children with vesicoureteric reflux (VUR). The purpose of this study was to investigate the possible correlation between the ACE deletion polymorphism and renal scarring in 186 children with urinary tract infection (UTI), of whom 90 were renal scar positive and 96 were renal scar negative. The control group consisted of 129 children with no UTI. Renal scars were diagnosed by means of (99m)Tc-dimercapto-succinic acid scans, and ACE genotypes were determined as II, ID, and DD by PCR analyses. The ACE genotype distribution was 10% II, 67% ID, and 23% DD in the renal scar-positive group, 18% IotaIota, 42% ID, and 40% DD in the renal scar-negative group, and 22% II, 47% ID, and 31% DD in the control group. No correlation was found between the DD genotype and renal scar formation in children with UTI. The same results were obtained following strafication of the patients by VUR and age of the first urinary tract infection. In conclusion, the results of this study suggest that the DD genotype is not an independent risk factor for renal scarring in children with UTI.

Genetic susceptibility to renal scar formation after urinary tract infection: a systematic review and meta-analysis of candidate gene polymorphisms

“…The study of the TGF-β1 (509)C > T polymorphism was performed by three groups in Korea, Egypt, and Poland, respectively [32,42,43]. The study of the ACE DD genotype was performed by four groups; three showed a OR>1 (two from Turkey [40,46] and one from the island of Crete [50]) and the fourth study showed an OR in the opposite direction (northern Greece [51]). It could be argued that the strong heterogeneity among the studies may be due to unknown geographic and/or socioeconomic and perhaps genetic background differences that cannot be evaluated in the meta-analyses.…”

“…Calculation disclosed that seven studies presented a significant deviation from HWE [32,41,42,48,[51][52][53]. In three studies, because of a lack of information, we were not able to calculate the HWE test in populations tested for the angiotensinogen (AGT) [46,47], angiotensin II type 1 receptor (AT1R) [46,47], AT2R [47], plasminogen activation inhibitor type 1 (PAI-1) [46], and tumor necrosis factor alpha (TNF-α) gene polymorphisms [50].…”

“…The HWE was assessed in seven studies [38,39,42,43,46,50,51]. Calculation disclosed that seven studies presented a significant deviation from HWE [32,41,42,48,[51][52][53].…”

“…Most studies (67%) did not give a sufficient description of how they diagnosed UTIs in their patients, whereas six studies reported that the UTIs were diagnosed based on clinical and laboratory investigations [32,38,39,42,43,51].…”

“…In the case of the recessive model (Fig. 2b), there was a statistically significant risk of renal scarring (P<0.05) but a high degree of between-study variability (I 2 >25%) [40,46,50,51]. The TGF-β1 c.-509 TT plus CT genotype (dominant model for allele -509 T; Fig.…”