The deletion polymorphism of the angiotensin-converting enzyme is associated with nephroangiosclerosis

The D allele of the angiotensin-converting enzyme (ACE) gene has been linke d with diabetic nephropathy and IgA glomerulonephritis and with faster rena l disease progression. The association of this allele with nephroangioscler osis has been scarcely investigated. We have tested this association in 45 hypertensive patients (all whites) with well defined nephroangioselerosis ( diagnosis established on the basis of renal biopsy in all cases) and modera te to severe renal failure. As studies of genetic association of small size often produce conflicting results, besides a control group of 343 Italian patients with essential hypertension and normal renal function, we elected to use also a very large control group of race-matched subjects taken from a meta-analysis of 27,565 whites, The proportion of patients with the D all ele (64%) was higher in patients with nephroangiosclerosis than that in Ita lian hypertensives (54%) and in whites (54%). DD and DI genotypes were more prevalent in patients than in control groups. The dominant model (DD and D I v II: nephroangiosclerosis v Italian controls: chi(2) = 6.19, P = .012; n ephroangiosclerosis v whites chi(2) = 6.86, P = .009) fitted the data bette r than the codominant and the recessive model (P < .022). The D allele is a ssociated with nephroangiosclerosis with a dominant effect in the sample of patients studied. Although intervention studies are needed to see whether these findings imply a causal association, our data suggest that this allel e may at least act as disease marker in nephroangiosclerosis. (C) 2000 Amer ican Journal of Hypertension, Ltd.