RENAL TUTULUMU OLAN HENOCH-SCHÖNLEİN PURPURALI HASTALARDA ANJİYOTENSİN KONVERTİNG ENZİM GEN POLİMORFİZMİNİN PROGNOZLA İLİŞKİSİ

Amaç: Henoch-Schönlein purpurası (HSP) sıklıkla çocukluk çağında görülen, nadiren böbrek yetersizliğine ilerleyebilen bir vaskülittir.Böbrek yetersizliğine gidişin mekanizması tam bilinmese de anjiyotensin konverting enzim (ACE) genindeki delesyon artan ACEaktivitesi ve artan lokal anjiyotensin-II konsantrasyonu ile ilişkilendirilmiştir. Bu çalışmada renal tutulumu olan HSP’lı hastalarda ACE genpolimorfizminin prognozla ilişkisini araştırmayı amaçladıkMateryal ve Metot: HSP nefriti tanılı ACE gen polimorfizmi çalışılmış 0-18 yaş arası 42 hasta çalışmaya alındı. Hastalar delesyon (DD)allelline sahip olanlar (Grup1) ile heterozigot delesyon (ID) veya insersiyon (II) allelline sahip olanlar (grup2) olarak ayrıldı; demografiközellikleri ve renal tutulumun ağırlık derecesi açısından karşılaştırıldı.Bulgular: Grup 1’de 15 erkek 14 kız toplam 29 hasta vardı, ortalama yaşları 8,26±3 yıl, izlem süreleri 3,34±2,1 yıldı. Grup 2’de 6 erkek 7kız toplam 13 hasta vardı, ortalama yaşları 7,92±3,1 yıl, izlem süreleri 2,1±1,9 yıl idi. İki grup arasında yaş, cinsiyet dağılımı ve izlemsüreleri bakımından istatiksel bir fark görülmedi (p=0,347, p=422, p=0,267). Grup 1’de 11 hastada hafif, 14 hastada orta, 4 hastada ciddirenal tutulum gözlendi. Grup 2’de 4 hastada hafif, 8 hastada orta, 1 hastada ciddi renal tutulum gözlendi. Renal tutulumun ağırlığıaçısından gruplar arasında istatiksel olarak anlamlı bir fark görülmedi (p=0,375). Proteinüri düzelme oranı grup1’de, grup2’den dahadüşüktü, sırası ile %31,2, %62,5, ancak vaka sayıları az olduğundan istatiksel olarak anlamlı bulunmadı (p=0,127) [ID veya II/ID(OR):3,667, (%95 Cl 0,619- 21,739)].Sonuç: Renal tutulumu olan HSP’li çocuklarda böbrek tutulumunun ağırlığı ile DD genotipi veya D allelli arasında anlamlı bir ilişkigörülmedi, ancak daha geniş ölçekli çalışmalara ihtiyaç vardır.

The Association of Angiotension Converting Enzyme Gene Polimorphism with Prognosis of Henoch- Schönlein Purpura with Renal Involvement in the Children

Aim: Henoch-Schönlein purpura (HSP) is a vasculitis rarely progresses to renal failure. The mechanism of renal failure in HSP has been associated with increased angiotensin converting enzyme (ACE) activity and increased local angiotension-II concentration as a result of deletion in ACE gene. Here relation between ACE gene polymorphism and prognosis of HSP nephritis was investigated. Materials and Methods: Forty-two children with HSP nephritis and ACE gene polymorphism studied were included in the study. Those who have deletion (DD) allele (Group-1) and heterozygous deletion (ID) or insertion (II) allele (Group-2)) compared according to their demographic characteristic, severity of renal involvement. Results: Between two groups, there was no statically difference in the terms of age, gender distribution and duration of follow-up (p=0,347, p=422, p=0,267). In group-1, 11 cases had mild, 14 had moderate, 4 had severe renal involvement. In group-2 4 cases had mild, 8 had moderate and 1 had severe renal involvement. There was no statistically significant difference in severity of renal involvement between two groups (p=0,375). Although there was a difference in proteinuria recovery rates between the two groups, the number of cases was not enough for statistical analysis (p=0,127) [ID or II / ID (OR): 3,667, (95% Cl 0.619-21.739). Conclusion: There was no significant association between the severity of renal involvement of HSP with DD genotype or D allele, however, this needs to be supported by studies with larger series.

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