Military Health Department, Ministry of Defance, Serbia
Doi
Abstract
Background/Aim. Diabetic nephropathy (DN) as a major microvascular
complication of diabetes mellitus (DM) include a progressive increase in
urinary albumin excretion in association with an increase in blood pressure
and to end stage renal failure. Hypertension connected with renin-angiotensin
system (RAS) hyperactivity and corresponding genotypes, angiotensinogen
(AGT), angiotensine-converting enzyme (ACE) and angiotensin II type 1
receptor (AT1R), predispose the increasing risk of DN. The aim of this study
was to assess the distribution of AGT, ACE and AT1R gene polymorphisms in
patients with type 1 DM according to the level of DN and patients clinical
characteristics. Methods. The study included 79 type 1 diabetic patients.
Inclusion criteria were: age between 20-40, duration of diabetes > 5 years,
and no other severe diseases. Clinical characteristics were gained from
interviewing the patients. Polymorphism was detected by polymerase chain
reaction (PCR) and restriction fragment length polymorphism using restriction
enzymes Psy I (Tth 111 I) and Hae III. Results. The patients with proteinuria
compared with normo- and microalbuminuric patients, highly differed in age,
diabetes duration, blood pressure level, hypertension, rethynopathy and
urinary albumin excretion values (p < 0.001). No statistically significant
difference between the groups was found for the ACE and AT1R gene
polymorphisms distribution. The presence of TT genotype of the M235T
polymorphism was significantly higher in the group with proteinuria (p <
0.05). The patients with hypertension raised nephropathy 5.2 times higher (OR
= 5.20, p < 0.05) while carriers of TT allel developed nephropathy 28.38
times higher (OR = 28.389, p < 0.01) than those with MM genotype. Conclusion.
Increased association of hypertension and TT angiotensinogen gene
polymorphism in patients with diabetes mellitus with proteinuria could be a
significant marker of diabetic nephropathy
