Abstract
Background and Aims
reflux nephropathy (RN) is the most serious complication of vesicoureteral reflux (VUR). The aim of the study was to assess the urinary level of MA (microalbumin) as an expression of tubulointerstitial damage depending of ACE genotype polymorphisms in children with VUR.
Method
94 patients, with VUR at the age from 3 year to 16 years (average age of 6.72 ± 0.68 years), including 65 girls (69,1%) were enrolled. As a control population to compare the distribution of genotypes and alleles of ACE gene used a sample of 100 healthy children (82girls), indigenous ethnic groups, mean age of 11.3 ± 5.4 years. To determine the gene polymorphism of ACE we used the method of polymerase chain reaction. Renal scar in DMSA scan was performed at least six months after urine tract infection (UTI). According to DMSA scan results, children were divided into 2 groups: gr. 1 - 12p. (VUR without RN), gr. 2 – 82 p. (VUR with RN). Urinary excretion of MA was measured by ELISA method.
Results
In gr. 1 is the frequency of genotype I/I amounted to 58%, I/D is 42% and D/D – is not detected. In the scar group (gr.2) frequency of genotype I/I is 12% (p1,2<0,05), I/D is 63% and (p>0.05), and D/D is 25% (p<0.05), respectively. In the distribution of I and D allele in children with VUR (71,3% of children with RN has got D allele). In RN groups with genotype D/D, the level of MA/Cr in the urine was 1,5 times higher than in children with genotype I/D (p<0.05) and 3-3,5 times higher than in patients with genotype I/I (р=0.0001). Significant difference in urinary levels of MA/Cr in the non scar group with genotype I/I and I/D is not revealed.
Conclusion
D/D-genotype of ACE may be a genetic susceptibility factor contributing to adverse renal prognosis – reflux nephropathy and presenting as risk factor for scar formation. A high urinary level of MA/Cr and positive correlation with genotype D/D is a significant and sensible marker of tubulointerstitial damage