Abstract
An insertion (I)/deletion (D) polymorphism of the angiotensin-converting-enzyme (ACE) gene influences the circulating and renal activity of the renin–angiotensin–aldosterone system. This Practice Point commentary discusses a 2008 paper by Parving et al. that analyzed the interaction between losartan and the I/D polymorphism in patients in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study. The investigators found that patients with type 2 diabetes and proteinuria who have the D allele have an unfavorable renal prognosis, which is improved by losartan treatment (vs placebo) when given together with conventional antihypertensive treatment. No significant improvement in outcomes was observed in losartan-treated patients with the II genotype. Previous observational studies had suggested a decreased beneficial effect of ACE inhibitors in patients with type 1 diabetic nephropathy who have the DD genotype. Prospective studies in this area are needed before I/D genotype characterization can be used to guide the choice of therapy in patients with diabetes and proteinuria.
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Acknowledgements
J Egido was supported by CAM (S2006/GEN-0247). A Ortiz was supported by the Promotion of Scientific Research Program in the National Health System of the Carlos III Health Institute and the Pedro Lain Entralgo Agency in Madrid, Spain.
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Egido, J., Ortiz, A. ACE gene polymorphism and the prognosis and treatment of overt diabetic nephropathy. Nat Rev Nephrol 4, 472–473 (2008). https://doi.org/10.1038/ncpneph0896
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DOI: https://doi.org/10.1038/ncpneph0896
