The D allele was thought to behave as a recessive trait, requiring the presence of two alleles to contribute to the progression of ESRF.[42] In addition, the II, ID and DD genotypes were previously demonstrated to display lowest, intermediate and highest levels of serum ACE levels, respectively.[19] In line with this, the DD genotype has always been held accountable for exerting its deleterious effects on various disease pathogenesis including diabetic nephropathy. This evidence concerns the gene ACE and diabetic kidney disease.