Angiotensinogen Gene M235T and T174M Polymorphisms in Diabetic Nephropathy in a Bangladeshi Population

Background: Marker gene polymorphisms linked with the renin-angiotensin-aldosterone system (RAAS) have been broadly studied in diabetic nephropathy (DN) patients considering that RAAS is a potential drug target to slow down kidney disease progression. Objectives: The aim of the present study was to determine the link between M235T and T174M variants of angiotensinogen (AGT) gene and DN. Methods: A total of 93 patients with DN, mean age of 56±8 years, systolic blood pressure (SBP) of 141±14, and diastolic blood pressure (DBP) of 84±7 mm Hg (mean±SD) were investigated, among whom 59 patients had a family history of type 2 diabetes mellitus. A total of 96 healthy subjects served as the control group with no family history of diabetic nephropathy (FHDN) and type 2 diabetes mellitus, a mean age of 47±10 years, SBP of 126±11, and DBP of 76±6 mm Hg. PCR–restriction fragment length polymorphism was employed for genotyping M235T and T174M molecular variants. Results: Genotype frequencies of the variants M235T (χ2=2.038, P=0.361) and T174M (χ2=2.952, P=0.229) did not show any statistically significant association with type 2 diabetic nephropathy (T2DN) compared to the control. Based on FHDN and family history of diabetes mellitus (FHDM), the frequency of genotypes of M235T marker (P=0.360) in FHDN, and (P=0.886) FHDM; T174M marker (P=0.641) in FHDN, and (P=0.425) FHDM also did not show any statistically significant association with T2DN compared to the controls. Conclusion: M235T and T174M variants were not associated with DN in a Bangladeshi population.

ROLE OF ABDOMINAL ULTRASOUND IN EVALUATION OF CHILDREN WITH SUSPECTED UPPER GASTROINTESTINAL DISEASE

OBJECTIVES

To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and describe the gastrointestinal disease patterns that can be evaluated by ultrasound.

DESIGN

Descriptive prospective study.

SETTING

Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi.

SUBJECTS

Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of one year five months. Seventy seven percent were two years and below.

RESULTS

Of the 56. children, six were normal on sonography; 18 (32.1%) had intussusception, 16 (28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejunal/ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male: female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with bloodstained stool. More than two thirds of the children with gastro-oesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusception,jejunal/ ileal atresia and enteric duplication cysts.

CONCLUSION

Trans-abdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionising radiation. Findings in this study confirm that ultrasound is an accurate, reliable and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.