ACE Gene Polymorphism and the Development of Microalbuminura in Korean Type 2 Diabetes Patients / 대한신장학회지

PURPOSE: Pathophysiological causes of the development and progression of diabetic nephropathy are not well known, but the angiotensin-converting enzyme (ACE) gene polymorphism has been proposed to be involved in its development. To clarify risk factors for the development of microalbuminuria in Korean type 2 diabetes patients, a retrospective study on the last 10 years was conducted on outpatients with type 2 diabetes. METHODS: The impact of insertion/deletion (I/D) genotypes on the progression of diabetic nephropathy in 105 Korean type 2 diabetes patients with normoalbuminuria at diagnosis was investigated by retrospective review of clinical data. Polymorphisms of the ACE gene were examined. RESULTS: During the follow up over the last 10 years, 23 of 105 patients developed Microalbuminuria (21.9%). ACE genotypes were D/D 19.5%, D/I 41.5%, I/I 39% in microalbuminuria group, as compared with D/D 17.4%, I/D 26.1%, I/I 56.5% in normoalbuminuria group. Higher levels of mean HbA1c and mean triglyceride were noted in microalbuminuira group, as compared with those in normoalbuminuria group. Kaplan-Meier survival curve showed that higher HbA1c and higher triglyceride level were significant predictors to the development of Microalbuminuria, but I/D genotype of ACE gene did not affect. Cox regression model also showed that higher HbA1c and triglyceride were independent variables. CONCLUSION: The control of blood glucose or lipid, rather than the genetic factors such as ACE polymorphism, was considered to be more influential factor on the development of microalbuminuria in Korean patients with type 2 diabetes mellitus.

The Study of Glutathione S-Trasferase M1 and T1 Genetic Polymorphism in Korean Type 2 Diabetic Nephropathy Patients / 대한신장학회잡지

BACKGROUND: Oxidative stress possiby contributes to the development of diabetic nephropathy. Glutathione S-transferases (GSTs) can work as one of endogenous antioxidants to protect cells from oxidative stress. The activity of GSTM1 or GSTT1 are determined genetically. The homologous deletion of the gene (null genotype) which reduced the GSTM1/T1 activity, may be associated with diabetic nephropathy development in diabetic patients. METHODS: We examined 94 patients with diabetic nephropathy and 102 patients without diabetic nephropathy in Korean type 2 diabetic patients. We used multiplex polymerase chain reaction (PCR) to analyze polymorphisms of two endogenous antioxidant genes, GSTM1 and GSTT1. RESULTS: The two patients groups were well matched with regard to age, body mass index, duration of diabetes and HbA1c. GSTM1 null genotype was observed in 50% of patients with nephropathy versus 51% of patients without nephropathy. GSTT1 null genotype was observed in 48.9% of patients with nephropathy versus 51% of patients without nephropathy. No association between homozygous deletion of GSTM1 or GSTT1 and development of diabetic nephropathy in diabetic patients. CONCLUSION: This study is the first to investigate the association of GSTM1/TT1 gene polymorphism which development of diabetic nephropathy in Korean type 2 diabetic patients. The present result suggest that GSTM1/TT1 null genotype does not contribute to the development of diabetic nephropathy in Korean type 2 diabetic patients.

A Case of Neuroleptic Malignant Syndrome (NMS) with Myoglobulinemic Acute Renal Failure and Lithium Intoxication due to Lithium-olanzapine Combination / 대한신장학회잡지

We report a patient developed neuroleptic malignant syndrome (NMS) with myoglobulinemic acute renal failure and lithium intoxication due to lithium-olanzapine combination, who was successfully treated by hemodiafiltration. A 34-year-old woman with a 14-year history of bipolar disorder had been treated with lithium-olanzapine during last four days. She was admitted to our hospital for muscular rigidity, hyperthermia and altered consciousness. On admission, rhabdomyolsis was demonstratd by biochemical methods and serum level of lithium was 3.78 mEq/L which was far above toxic level. After the diagnosis of NMS with acute renal failure and lithium intoxication, olanzapine and lithium were discontinued and conservative measures and continuous venovenous hemodiafiltration were instituted. She recovered without any neurologic sequelae.