Association of Angiotensin-Converting Enzyme Insertion/Deletion Gene Polymorphism with Idiopathic Nephrotic Syndrome Susceptibility in Children: An Updated Meta-Analysis

Dear Editor

Idiopathic nephrotic syndrome (INS) is a risk disease in children and is prone to develop into end-stage renal disease. Some investigations suggested that the genetic factor might play an important role in the susceptibility of INS. We previously performed a meta-analysis to explore the relationship between angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) gene polymorphism and INS susceptibility in children, and the search for this meta-analysis was conducted on 1 September 2010.¹ We found that there was a positive association between D allele/DD genotype and INS susceptibility in Asian children, but not for Caucasian children and African children. However, Prasun et al.² reported an investigation on the association of ACE I/D gene polymorphism with INS risk in 2011, and we had not included this study into our previous meta-analysis. They showed that the frequency of the DD genotype was significantly increased in children with INS compared with control subjects.

Prasun et al.² performed investigations in Asian children. As those mentioned above, we included the study of Prasun et al.,² and reran the meta-analysis for the overall population and for Asian children. In this analysis, we also did not include those studies that did not report whether the patients were suffering from INS or nephrotic syndrome in detail, and we only recruited those reports for INS. We found that the D allele was associated with INS risk in Asian population [odds ratio (OR) = 1.87, 95% confidence interval (CI): 1.26–2.78; p = 0.002]. DD genotype in Asians was also associated with the INS risk (OR = 2.17, 95% CI: 1.29–3.67; p = 0.004). It seemed that II genotype might play a protective role against INS risk in Asian children (OR = 0.53, 95% CI: 0.35–0.80; p = 0.002). This result was consistent with our previous result for Asian population. Furthermore, we also found that the ACE I/D gene polymorphism was in association with INS risk in the overall population (D: p = 0.009; DD: p = 0.01; II: p = 0.002). This result for the overall population was also consistent with our previous result.

The results presented above indicated that the D allele or DD genotype might be a risk factor for INS in Asian children and for the overall population. The conclusion from the re-run meta-analysis might indicate that our previous results were robust.

Tian-Biao Zhou

Department of Pediatrics, The First Affiliated Hospital

of GuangXi Medical University, Nanning, PR China

E-mail: [email protected]