| The Treatment Response to Angiotensin Receptor Blocker According to ACE Gene Polymorphism in Patients with IgA Nephropathy |
| Mina Park, M.D., Kyung-Hwan Jeong, M.D., Joo-Young Mon, M.D. Tae-won Lee, M.D., Chun-Gyoo Ihm, M.D. and Sang-Ho Lee, M.D. |
| Department of Internal Medicine, Division of Nephrology Kyung Hee University, College of Medicine, Seoul, Korea |
| 원저 : IgA 신병증 환자에게 있어 ACE 유전자 다형성에 따른 Angiotensin receptor blocker의 치료 효과 |
| 박미나•정경환•문주영•이태원•임천규•이상호 |
| 경희대학교 의과대학 신장내과학교실 |
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| Abstract |
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Purpose : Each and every patients therapeutic response to ACE inhibitor in IgA nephropathy can be different. The diversity may be caused by ACE polymorphism. The previous studies did not reveal the consistency of relation between ACE polymorphism and ACE inhibitor. We consider the incomplete blockade of ACE inhibitor for RAAS is the one of various reasons. We evaluated the relation between ACE polymorphism and ARB in IgA nephropathy.
Methods : Among patients confirmed in IgA nephropathy and treated with ARB, 40 patients with over 0.5 g/day proteinuria and less 1.5 mg/dL serum creatinine were reviewed. Genomic DNA was extracted from blood and PCR was performed. Complete response was defined that proteinuria was less than 0.3 g/day after treatment. Partial response was defined that proteinuria was decreased over than 50%, but more than 0.3 g/day. Non-response was defined that proteinuria was decreased less than 50%.
Results : The median follow-up duration was 6 months (95% Cl, 5.5-7.9). The serum creatinine was 1.2±0.6 mg/dL and median proteinuria was 1.6 g/day (95% Cl, 1.4-2.3). 15 complete responses, 11 partial responses and 14 non-responses were observed. The differences in the therapeutic response to ARB were observed according to ACE polymorphism (p=0.02). The response rate among each group was II:ID:DD=43%:68%:100% (p=0.03), and there was a significant difference in the therapeutic response to ARB between the DD/ID genotype and the II genotype (p=0.01).
Conclusion : In IgA nephropathy, there was a significant relation between the therapeutic response to ARB and the ACE polymorphism. Especially DD/ID genotype revealed better response to ARB than II genotype.
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| Key Words:
Genetic polymorphism, Angiotensin converting enzyme, IgA nephropathy |
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