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Yen PW, Chen YA, Wang W, Mao FS, Chao CT, Chiang CK, Lin SH, Tarng DC, Chiu YW, Wu MJ, Chen YC, Kao JTW, Wu MS, Lin CL, Huang JW, Hung KY. The screening, diagnosis, and management of patients with autosomal dominant polycystic kidney disease: A national consensus statement from Taiwan. Nephrology (Carlton) 2024; 29:245-258. [PMID: 38462235 DOI: 10.1111/nep.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of end-stage kidney disease (ESKD) worldwide. Guidelines for the diagnosis and management of ADPKD in Taiwan remains unavailable. In this consensus statement, we summarize updated information on clinical features of international and domestic patients with ADPKD, followed by suggestions for optimal diagnosis and care in Taiwan. Specifically, counselling for at-risk minors and reproductive issues can be important, including ethical dilemmas surrounding prenatal diagnosis and pre-implantation genetic diagnosis. Studies reveal that ADPKD typically remains asymptomatic until the fourth decade of life, with symptoms resulting from cystic expansion with visceral compression, or rupture. The diagnosis can be made based on a detailed family history, followed by imaging studies (ultrasound, computed tomography, or magnetic resonance imaging). Genetic testing is reserved for atypical cases mostly. Common tools for prognosis prediction include total kidney volume, Mayo classification and PROPKD/genetic score. Screening and management of complications such as hypertension, proteinuria, urological infections, intracranial aneurysms, are also crucial for improving outcome. We suggest that the optimal management strategies of patients with ADPKD include general medical care, dietary recommendations and ADPKD-specific treatments. Key points include rigorous blood pressure control, dietary sodium restriction and Tolvaptan use, whereas the evidence for somatostatin analogues and mammalian target of rapamycin (mTOR) inhibitors remains limited. In summary, we outline an individualized care plan emphasizing careful monitoring of disease progression and highlight the need for shared decision-making among these patients.
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Affiliation(s)
- Pao-Wen Yen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yung-An Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wei Wang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Fang-Sheng Mao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Chih-Kang Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Juliana Tze-Wah Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Fu-Jen Catholic University Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Liang Lin
- Division of Nephrology, Department of Internal Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi County, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
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Jdiaa SS, Husainat NM, Mansour R, Kalot MA, McGreal K, Chebib FT, Perrone RD, Yu A, Mustafa RA. A Systematic Review of Reported Outcomes in ADPKD Studies. Kidney Int Rep 2022; 7:1964-1979. [PMID: 36090492 PMCID: PMC9459055 DOI: 10.1016/j.ekir.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Methods Results Conclusion
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Norcia LF, Watanabe EM, Hamamoto Filho PT, Hasimoto CN, Pelafsky L, de Oliveira WK, Sassaki LY. Polycystic Liver Disease: Pathophysiology, Diagnosis and Treatment. Hepat Med 2022; 14:135-161. [PMID: 36200122 PMCID: PMC9528914 DOI: 10.2147/hmer.s377530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
Polycystic liver disease (PLD) is a clinical condition characterized by the presence of more than 10 cysts in the liver. It is a rare disease Of genetic etiology that presents as an isolated disease or assoc\iated with polycystic kidney disease. Ductal plate malformation, ciliary dysfunction, and changes in cell signaling are the main factors involved in its pathogenesis. Most patients with PLD are asymptomatic, but in 2–5% of cases the disease has disabling symptoms and a significant reduction in quality of life. The diagnosis is based on family history of hepatic and/or renal polycystic disease, clinical manifestations, patient age, and polycystic liver phenotype shown on imaging examinations. PLD treatment has evolved considerably in the last decades. Somatostatin analogues hold promise in controlling disease progression, but liver transplantation remains a unique curative treatment modality.
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Affiliation(s)
- Luiz Fernando Norcia
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
- Correspondence: Luiz Fernando Norcia, Department of Surgery, São Paulo State University (UNESP), Medical School, 783 Pedro Delmanto Street, Botucatu, São Paulo, 18610-303, Brazil, Tel +55 19982840542, Email
| | - Erika Mayumi Watanabe
- Department of Radiology, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Claudia Nishida Hasimoto
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Leonardo Pelafsky
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Walmar Kerche de Oliveira
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
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Raina R, Chakraborty R, DeCoy ME, Kline T. Autosomal-dominant polycystic kidney disease: tolvaptan use in adolescents and young adults with rapid progression. Pediatr Res 2021; 89:894-899. [PMID: 32392574 DOI: 10.1038/s41390-020-0942-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The phase 3 Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO 3:4) clinical trial demonstrated the beneficial effect of tolvaptan on kidney growth and function in subjects aged 18-50 years over a 3-year period. However, it did not specifically assess the use of tolvaptan in adolescents and young adults (AYAs) with ADPKD. METHODS A post hoc analysis of the TEMPO 3:4 trials was performed for patients aged 18-24 years. The primary outcome was the annual rate of change in total kidney volume (TKV). The secondary outcome was to evaluate long-term safety of tolvaptan using Hy's law of hepatotoxicity. RESULTS A total of 51 patients in the 18-24 age group were analyzed (tolvaptan: 29, placebo: 22). The tolvaptan group had a lower mean percentage of TKV growth per year compared to the placebo group (3.9% vs. 6.5%, P = 0.0491). For secondary outcomes, 63 patients in the AYA subgroup were evaluated. In both the AYA and adult groups, none of the patients met the criteria for Hy's law of hepatotoxicity. CONCLUSIONS This post hoc analysis suggests that tolvaptan, with appropriate patient selection and management, can provide effective and acceptably safe treatment in AYAs with ADPKD. IMPACT Tolvaptan slows the increase in total kidney volume in patients aged 18-24 years with ADPKD. Tolvaptan posed no risk of potential liver injury measured via Hy's law of hepatotoxicity in the AYA stratum. This study suggests that tolvaptan has beneficial outcomes in AYAs. This post hoc analysis suggests the need for additional studies with a larger pediatric patient population. The impact is significant as tolvaptan had not been specifically examined in the AYA patient population previously.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
| | | | - Meredith E DeCoy
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
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Iyer NN, Vendetti NJ, Levy DI, Mardekian J, Mychaskiw MA, Thomas J. Incremental health care resource utilization and expenditures associated with autosomal-dominant polycystic kidney disease. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:693-703. [PMID: 30464562 PMCID: PMC6216970 DOI: 10.2147/ceor.s167837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Incremental health care resource utilization and expenditures associated with autosomal dominant polycystic kidney disease (ADPKD) were estimated. Methods Study data were from a large administrative claims database. Individuals aged 18 years or older enrolled in tracked health plans for 12 months from April 1, 2011 through March 31, 2012, and with an International Classification of Disease, Ninth Revision, Clinical Modification diagnosis code for "polycystic kidney, autosomal dominant" (753.13) or for "polycystic kidney, unspecified type" (753.12) were identified as having ADPKD, and linked one-to-one with individuals without ADPKD based on age and gender. Zero-inflated negative binomial models estimated incremental health care resource utilization and expenditures, adjusting for risk factors. Results A total of 3,844 individuals with ADPKD who satisfied selection criteria were linked one-to-one with 3,844 individuals without ADPKD. Multivariate, regression models adjusting for risk factors revealed incremental mean (standard error) resource use associated with ADPKD of 0.68 (0.090) hospital days, equal to 68 additional hospital days per 100 ADPKD patients, and 6.9 (0.28) outpatient visits, equal to 690 additional visits per 100 ADPKD patients. Mean (standard error) incremental total expenditures associated with ADPKD were US$8,639 ($470). Mean incremental expenditures were largest for outpatient expenditures at US$4,918 ($198), followed by mean incremental hospital expenditures of US$2,603 ($263), and mean incremental medication expenditures of US$1,589 ($77). Based on sub-group analysis, mean incremental total expenditures were US$2,944 ($417) among ADPKD patients without end-stage renal disease and US$38,962 ($6,181) for those with end-stage renal disease. Conclusion ADPKD was associated with considerable incremental health care resource utilization and expenditures. Significant illness burden was found even before patients reached end-stage renal disease.
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Affiliation(s)
- Neeraj N Iyer
- Regenstrief Center for Healthcare Engineering and Center for Health Outcomes Research and Policy, College of Pharmacy, Purdue University, West Lafayette, IN, USA,
| | | | - Daniel I Levy
- Rare Disease Group, Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - Jack Mardekian
- Biostatistics, Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | | | - Joseph Thomas
- Regenstrief Center for Healthcare Engineering and Center for Health Outcomes Research and Policy, College of Pharmacy, Purdue University, West Lafayette, IN, USA,
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Wong MY, McCaughan GW, Strasser SI. An update on the pathophysiology and management of polycystic liver disease. Expert Rev Gastroenterol Hepatol 2017; 11:569-581. [PMID: 28317394 DOI: 10.1080/17474124.2017.1309280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Polycystic liver disease (PLD) is characterized by the presence of multiple cholangiocyte-derived hepatic cysts that progressively replace liver tissue. They are classified as an inherited ciliopathy /cholangiopathy as pathology exists at the level of the primary cilia of cholangiocytes. Aberrant expression of the proteins in primary cilia can impair their structures and functions, thereby promoting cystogenesis. Areas covered: This review begins by looking at the epidemiology of PLD and its natural history. It then describes the pathophysiology and corresponding potential treatment strategies for PLD. Expert commentary: Traditionally, therapies for symptomatic PLD have been limited to symptomatic management and surgical interventions. Such techniques are not completely effective, do not alter the natural history of the disease, and are linked with high rate of re-accumulation of cysts. As a result, there has been a push for drugs targeted at abnormal cellular signaling cascades to address deregulated proliferation, cell dedifferentiation, apoptosis and fluid secretion. Currently, the only available drug treatments that halt disease progression and improve quality of life in PLD patients are somatostatin analogues. Numerous preclinical studies suggest that targeting components of the signaling pathways that influence cyst development can ameliorate growth of hepatic cysts.
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Affiliation(s)
- May Yw Wong
- a AW Morrow Gastroenterology and Liver Centre , Royal Prince Alfred Hospital and University of Sydney , Sydney , Australia
| | - Geoffrey W McCaughan
- a AW Morrow Gastroenterology and Liver Centre , Royal Prince Alfred Hospital and University of Sydney , Sydney , Australia
| | - Simone I Strasser
- a AW Morrow Gastroenterology and Liver Centre , Royal Prince Alfred Hospital and University of Sydney , Sydney , Australia
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Marlais M, Cuthell O, Langan D, Dudley J, Sinha MD, Winyard PJD. Hypertension in autosomal dominant polycystic kidney disease: a meta-analysis. Arch Dis Child 2016; 101:1142-1147. [PMID: 27288429 DOI: 10.1136/archdischild-2015-310221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/05/2016] [Accepted: 05/20/2016] [Indexed: 11/04/2022]
Abstract
CONTEXT Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that can cause hypertension during childhood, but the true prevalence of hypertension during childhood is not known. OBJECTIVE We undertook a systematic review and meta-analysis to determine the prevalence of hypertension in children with ADPKD. DATA SOURCES Systematic review of articles published between 1980 and 2015 in MEDLINE and EMBASE. STUDY SELECTION Studies selected by two authors independently if reporting data on prevalence of hypertension in children and young persons aged <21 years with a diagnosis of ADPKD. Observational series were included with study populations of >15 children. Articles were excluded if inadequate diagnostic criteria for hypertension were used. Studies with selection bias were included but analysed separately. DATA EXTRACTION Data extracted on prevalence of hypertension, proteinuria and reduced renal function using standardised form. Meta-analysis was performed to calculate weighted mean prevalence. RESULTS 903 articles were retrieved from our search; 14 studies met the inclusion criteria: 1 prospective randomised controlled trial; 8 prospective observational studies; and 5 retrospective cross-sectional studies. From 928 children with clinically confirmed ADPKD, 20% (95% CI 15% to 27%) were hypertensive. The estimated prevalence of proteinuria in children with ADPKD is 20% (8 studies; 95% CI 9% to 40%) while reduced renal function occurred in 8% (5 studies; 95% CI 2% to 26%). LIMITATIONS Studies showed a high degree of methodological heterogeneity (I2=73.4%, τ2=0.3408, p<0.0001). Most studies did not use ambulatory blood pressure (BP) monitoring to diagnose hypertension. CONCLUSIONS In this meta-analysis we estimate 20% of children with ADPKD have hypertension. In the population, many children with ADPKD are not under regular follow-up and remain undiagnosed. We recommend that all children at risk of ADPKD have regular BP measurement.
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Affiliation(s)
- Matko Marlais
- Institute of Child Health, University College London, London, UK
| | - Oliver Cuthell
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Dean Langan
- Institute of Child Health, University College London, London, UK
| | - Jan Dudley
- Department of Paediatric Nephrology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Paul J D Winyard
- Institute of Child Health, University College London, London, UK
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KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Management of Polycystic Liver Disease. Semin Nephrol 2016; 35:618-622.e5. [PMID: 26718168 DOI: 10.1016/j.semnephrol.2015.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rangan GK, Lee VW, Alexander SI, Patel C, Tunnicliffe DJ, Vladica P. KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Screening for Polycystic Kidney Disease. Semin Nephrol 2016; 35:557-564.e6. [PMID: 26718159 DOI: 10.1016/j.semnephrol.2015.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gopala K Rangan
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, Australia.
| | - Vincent W Lee
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, Australia
| | - Stephen I Alexander
- Centre for Kidney Research and the Department of Nephrology, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David J Tunnicliffe
- KHA-CARI Guidelines, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Philip Vladica
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Westmead, Sydney, Australia
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Kim JA, Blumenfeld JD, Chhabra S, Dutruel SP, Thimmappa ND, Bobb WO, Donahue S, Rennert HE, Tan AY, Giambrone AE, Prince MR. Pancreatic Cysts in Autosomal Dominant Polycystic Kidney Disease: Prevalence and Association with PKD2 Gene Mutations. Radiology 2016; 280:762-70. [PMID: 27046073 DOI: 10.1148/radiol.2016151650] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To define the magnetic resonance (MR) imaging prevalence of pancreatic cysts in a cohort of patients with autosomal dominant polycystic kidney disease (ADPKD) compared with a control group without ADPKD that was matched for age, sex, and renal function. Materials and Methods In this HIPAA-compliant, institutional review board-approved study, all patients with ADPKD provided informed consent; for control subjects, informed consent was waived. Patients with ADPKD (n = 110) with mutations identified in PKD1 or PKD2 and control subjects without ADPKD or known pancreatic disease (n = 110) who were matched for age, sex, estimated glomerular filtration rate, and date of MR imaging examination were evaluated for pancreatic cysts by using axial and coronal single-shot fast spin-echo T2-weighted images obtained at 1.5 T. Total kidney volume and liver volume were measured. Univariate and multivariable logistic regression analyses were conducted to evaluate potential associations between collected variables and presence of pancreatic cysts among patients with ADPKD. The number, size, location, and imaging characteristics of the cysts were recorded. Results Patients with ADPKD were significantly more likely than control subjects to have at least one pancreatic cyst (40 of 110 patients [36%] vs 25 of 110 control subjects [23%]; P = .027). In a univariate analysis, pancreatic cysts were more prevalent in patients with ADPKD with mutations in PKD2 than in PKD1 (21 of 34 patients [62%] vs 19 of 76 patients [25%]; P = .0002). In a multivariable logistic regression model, PKD2 mutation locus was significantly associated with the presence of pancreatic cysts (P = .0004) and with liver volume (P = .038). Patients with ADPKD and a pancreatic cyst were 5.9 times more likely to have a PKD2 mutation than a PKD1 mutation after adjusting for age, race, sex, estimated glomerular filtration rate, liver volume, and total kidney volume. Conclusion Pancreatic cysts were more prevalent in patients with ADPKD with PKD2 mutation than in control subjects or patients with PKD1 mutation. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jin Ah Kim
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Jon D Blumenfeld
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Shalini Chhabra
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Silvina P Dutruel
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Nanda Deepa Thimmappa
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Warren O Bobb
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Stephanie Donahue
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Hanna E Rennert
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Adrian Y Tan
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Ashley E Giambrone
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
| | - Martin R Prince
- From the Departments of Radiology (J.K., S.C., S.P.D., N.D.T., M.R.P.), Medicine (J.D.B.), Pathology (H.E.R., A.Y.T.), and Healthcare Policy and Research (A.E.G.), Weill Cornell Medical College and New York Presbyterian Hospital, 416 E 55th St, New York, NY 10022; and the Rogosin Institute, New York, NY (J.D.B., W.O.B., S.D., H.E.R., A.Y.T.)
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Mai J, W. Lee V, Lopez-Vargas P, Vladica P, Rangan GK. KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Monitoring Disease Progression. Semin Nephrol 2015; 35:565-571.e18. [DOI: 10.1016/j.semnephrol.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Pietrzak-Nowacka M, Safranow K, Palacz J, Gołembiewska E, Marchelek-Myśliwiec M, Ciechanowski K. Association of kidney and cysts dimensions with anthropometric and biochemical parameters in patients with ADPKD. Ren Fail 2015; 37:798-803. [DOI: 10.3109/0886022x.2015.1033608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Büscher R, Büscher AK, Weber S, Mohr J, Hegen B, Vester U, Hoyer PF. Clinical manifestations of autosomal recessive polycystic kidney disease (ARPKD): kidney-related and non-kidney-related phenotypes. Pediatr Nephrol 2014; 29:1915-25. [PMID: 24114580 DOI: 10.1007/s00467-013-2634-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 02/23/2023]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD), although less frequent than the dominant form, is a common, inherited ciliopathy of childhood that is caused by mutations in the PKHD1-gene on chromosome 6. The characteristic dilatation of the renal collecting ducts starts in utero and can present at any stage from infancy to adulthood. Renal insufficiency may already begin in utero and may lead to early abortion or oligohydramnios and lung hypoplasia in the newborn. However, there are also affected children who have no evidence of renal dysfunction in utero and who are born with normal renal function. Up to 30 % of patients die in the perinatal period, and those surviving the neonatal period reach end stage renal disease (ESRD) in infancy, early childhood or adolescence. In contrast, some affected patients have been diagnosed as adults with renal function ranging from normal to moderate renal insufficiency to ESRD. The clinical spectrum of ARPKD is broader than previously recognized. While bilateral renal enlargement with microcystic dilatation is the predominant clinical feature, arterial hypertension, intrahepatic biliary dysgenesis remain important manifestations that affect approximately 45 % of infants. All patients with ARPKD develop clinical findings of congenital hepatic fibrosis (CHF); however, non-obstructive dilation of the intrahepatic bile ducts in the liver (Caroli's disease) is seen at the histological level in only a subset of patients. Cholangitis and variceal bleeding, sequelae of portal hypertension, are life-threatening complications that may occur more often in advanced cases of liver disease. In this review we focus on common and uncommon kidney-related and non-kidney-related phenotypes. Clinical management of ARPKD patients should include consideration of potential problems related to these manifestations.
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Affiliation(s)
- Rainer Büscher
- Children's Hospital, Pediatrics II, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany,
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Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 or PKD2, which encode polycystin-1 and polycystin-2, respectively. Rodent models are available to study the pathogenesis of polycystic kidney disease (PKD) and for preclinical testing of potential therapies-either genetically engineered models carrying mutations in Pkd1 or Pkd2 or models of renal cystic disease that do not have mutations in these genes. The models are characterized by age at onset of disease, rate of disease progression, the affected nephron segment, the number of affected nephrons, synchronized or unsynchronized cyst formation and the extent of fibrosis and inflammation. Mouse models have provided valuable mechanistic insights into the pathogenesis of PKD; for example, mutated Pkd1 or Pkd2 cause renal cysts but additional factors are also required, and the rate of cyst formation is increased in the presence of renal injury. Animal studies have also revealed complex genetic and functional interactions among various genes and proteins associated with PKD. Here, we provide an update on the preclinical models commonly used to study the molecular pathogenesis of ADPKD and test potential therapeutic strategies. Progress made in understanding the pathophysiology of human ADPKD through these animal models is also discussed.
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Affiliation(s)
- Hester Happé
- Department of Human Genetics, Leiden University Medical Center, S4-P, PO Box 9600, Albinusdreef 2, Leiden, 2333 ZA Leiden, Netherlands
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Center, S4-P, PO Box 9600, Albinusdreef 2, Leiden, 2333 ZA Leiden, Netherlands
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Lodh S, O’Hare EA, Zaghloul NA. Primary cilia in pancreatic development and disease. BIRTH DEFECTS RESEARCH. PART C, EMBRYO TODAY : REVIEWS 2014; 102:139-58. [PMID: 24864023 PMCID: PMC4213238 DOI: 10.1002/bdrc.21063] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/30/2014] [Accepted: 03/30/2014] [Indexed: 01/04/2023]
Abstract
Primary cilia and their anchoring basal bodies are important regulators of a growing list of signaling pathways. Consequently, dysfunction in proteins associated with these structures results in perturbation of the development and function of a spectrum of tissue and cell types. Here, we review the role of cilia in mediating the development and function of the pancreas. We focus on ciliary regulation of major pathways involved in pancreatic development, including Shh, Wnt, TGF-β, Notch, and fibroblast growth factor. We also discuss pancreatic phenotypes associated with ciliary dysfunction, including pancreatic cysts and defects in glucose homeostasis, and explore the potential role of cilia in such defects.
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Affiliation(s)
- Sukanya Lodh
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth A. O’Hare
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Norann A. Zaghloul
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Zingg-Schenk A, Caduff J, Azzarello-Burri S, Bergmann C, Drenth JPH, Neuhaus TJ. Boy with autosomal recessive polycystic kidney and autosomal dominant polycystic liver disease. Pediatr Nephrol 2012; 27:1197-200. [PMID: 22415584 DOI: 10.1007/s00467-012-2137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 02/08/2012] [Accepted: 02/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) shows a great phenotypic variability between patients, ranging from perinatal demise to mildly affected adults. Autosomal dominant polycystic liver disease (PCLD) does not manifest in childhood. CASE-DIAGNOSIS/TREATMENT A boy was reported with the co-occurrence of ARPKD and PCLD. He presented at the age of 16 days with pyelonephritis and urosepsis. Subsequent investigations showed enlarged kidneys and hyperechogenic renal medulla and liver parenchyma. Genetic analysis revealed compound heterozygous mutations in the PKHD1 gene (p.Arg496X and p.Ser1862Leu). After his mother was diagnosed with PCLD, the finding of a liver cyst on ultrasound prompted analysis of the PRKCSH gene, revealing a missense mutation (p.Arg139His). At the most recent follow-up at 13 years of age, the patient's course and clinical examination was uneventful with normal renal and liver function without evidence of portal hypertension. CONCLUSIONS The patient with ARPKD and PCLD has so far demonstrated a benign clinical outcome, consistent with the great phenotypic variability of ARPKD and, apart from the liver cyst, asymptomatic manifestation of PCLD in childhood. However, close long-term follow-up is mandatory.
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18
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Temmerman F, Missiaen L, Bammens B, Laleman W, Cassiman D, Verslype C, van Pelt J, Nevens F. Systematic review: the pathophysiology and management of polycystic liver disease. Aliment Pharmacol Ther 2011; 34:702-13. [PMID: 21790682 DOI: 10.1111/j.1365-2036.2011.04783.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Polycystic liver diseases (PCLD) represent a group of genetic disorders in which cysts occur solely in the liver, or together with renal cysts. Most of the patients with PCLD are asymptomatic, however, in some patients, expansion of liver cysts causes invalidating abdominal symptoms. AIM To provide a systemic review on the pathophysiology and management of PCLD. METHODS A PubMed search was undertaken to identify relevant literature using search terms including polycystic liver disease, pathophysiology, surgical and medical management. RESULTS The most common complication in patients with PCLD is extensive hepatomegaly, which may lead to malnutrition and can be lethal. Conservative surgical approaches are only partially effective and do not change the natural course of the disease. Liver transplantation has been successfully performed in PCLD, however, in an era of organ shortage, medical management needs to be evaluated. A better understanding of the pathophysiology and the availability of animal models have already identified promising drugs. Abnormalities in cholangiocyte proliferation/apoptosis and enhanced fluid secretion are key factors in the pathophysiology. It has been demonstrated in rodents and in humans that somatostatin analogues diminish liver volume. The role of the inhibitors of the mammalian target of rapamycin (mTOR) in the management of PCLD is still under investigation. CONCLUSIONS The exact pathophysiology of polycystic liver disease still remains unclear. In symptomatic patients, none of the currently available surgical options except liver transplantation have been shown to change the natural course of the disease. The use of somatostatin analogues has been shown to diminish liver volume.
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Affiliation(s)
- F Temmerman
- Department of Hepatology, UZ Gasthuisberg, K.U. Leuven, Leuven, Belgium
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19
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Hogan MC, Norby SM. Evaluation and management of pain in autosomal dominant polycystic kidney disease. Adv Chronic Kidney Dis 2010; 17:e1-e16. [PMID: 20439087 DOI: 10.1053/j.ackd.2010.01.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 01/29/2023]
Abstract
Transient episodes of pain are common in autosomal dominant polycystic kidney disease (ADPKD). A small fraction of patients have disabling chronic pain. In this review, we discuss the etiologies of pain in ADPKD; review how ADPKD patients should be assessed; and discuss medical, surgical, and other management options.
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Catalá V, Martí T, Diaz JM, Cordeiro E, Samaniego J, Rosales A, De La Torre P. Use of Multidetector CT in Presurgical Evaluation of Potential Kidney Transplant Recipients. Radiographics 2010; 30:517-31. [DOI: 10.1148/rg.302095080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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21
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Abstract
Autosomal dominant polycystic kidney disease is the most prevalent, potentially lethal, monogenic disorder. It is associated with large interfamilial and intrafamilial variability, which can be explained to a large extent by its genetic heterogeneity and modifier genes. An increased understanding of the disorder's underlying genetic, molecular, and cellular mechanisms and a better appreciation of its progression and systemic manifestations have laid out the foundation for the development of clinical trials and potentially effective treatments.
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Affiliation(s)
| | | | - Yves Pirson
- Cliniques St Luc, Université Catholique de Louvain, Brussels, Belgium
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22
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Abstract
Diagnosis and treatment of autosomal dominant polycystic kidney disease (ADPKD) is rapidly changing. Cellular pathways that involve the polycystins are being mapped and involve the primary cilium, intracellular calcium and cAMP regulation, and the mammalian target of rapamycin (mTOR) pathway. With the use of new imaging approaches, earlier diagnosis of hepatic cystic disease is possible, and measurement of kidney and cystic growth as well as kidney blood flow is possible over relatively short periods. PKD gene type, gender, proteinuria, and the presence of hypertension relate to the rate of kidney growth in ADPKD. On the basis of risk factors for progression to ESRD and the pathogenic roles that intracellular cAMP and mTOR play in cystogenesis, novel therapies are now being tested, including maximal inhibition of the renin-angiotensin system, inhibition of renal intracellular cAMP using vasopressin V2 receptor antagonists, and somatostatin analogues, as well as inhibitors of mTOR. This review addresses the current understanding of the pathogenesis and the natural history of ADPKD; accuracy and reliability of diagnostic approaches in utero, childhood, and adulthood; the value of reliable magnetic resonance imaging to measure disease progression early in the course of ADPKD; and novel therapeutic approaches that are being evaluated in ADPKD.
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Affiliation(s)
- Arlene B Chapman
- Emory University School of Medicine, 1639 Pierce Drive, Atlanta, GA 30322, USA.
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24
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Lee YR, Lee KB. Reliability of magnetic resonance imaging for measuring the volumetric indices in autosomal-dominant polycystic kidney disease: correlation with hypertension and renal function. Nephron Clin Pract 2006; 103:c173-80. [PMID: 16636585 DOI: 10.1159/000092915] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 12/30/2005] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine if renal volumetric indices can be accurately measured using MRI, and if these volumetric indices are associated with hypertension and renal function in patients with autosomal-dominant polycystic kidney disease (ADPKD). METHODS For testing the accuracy of the MRI-based volume measurements that we proposed for clinical trial, we designed phantoms to simulate cysts within the kidney. Fifty-six patients with ADPKD were included in this study, and their respiratory compensated T2-weighted fast spin-echo images were acquired. The total kidney volume (Vt), cyst volume (Vc), and noncystic parenchymal volume (Vp) were measured and the percent cyst volume (Pc) was calculated. These volumetric indices were compared with the disease progression in the ADPKD patients. RESULTS The MRI measures of the phantoms were accurate. The Vt, Vc and Pc were significantly greater in the hypertensive group (n = 35) than in the normotensive group (n = 21) (p < 0.01). The Vt, Vc and Pc were significantly greater in the renal failure group (n = 23) than in the normal renal function group (n = 33) (p < 0.01). The Vt, Vc, and Pc were inversely correlated with the creatinine clearance. CONCLUSION MRI is a reliable method to measure renal volumetric indices. The MRI-based volume measurements can be employed as useful markers for the progression of disease in ADPKD patients.
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Affiliation(s)
- Young Rae Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jong-no ku, Seoul, Korea
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25
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Pierreux CE, Poll AV, Kemp CR, Clotman F, Maestro MA, Cordi S, Ferrer J, Leyns L, Rousseau GG, Lemaigre FP. The transcription factor hepatocyte nuclear factor-6 controls the development of pancreatic ducts in the mouse. Gastroenterology 2006; 130:532-41. [PMID: 16472605 DOI: 10.1053/j.gastro.2005.12.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 11/02/2005] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS A number of hereditary polycystic diseases are associated with formation of cysts within the pancreatic ducts. The cysts result from abnormal tubulogenesis, but how normal pancreatic duct development is controlled remains poorly understood. Here, we investigate the transcriptional mechanisms that control pancreatic duct development by addressing the role of the transcription factor hepatocyte nuclear factor (HNF)-6. METHODS Using immunostaining, we have determined the expression pattern of HNF-6 in pancreatic ducts during mouse development. Hnf6 null mice at various stages of development were studied by immunolocalization methods to assess the morphology, differentiation, and proliferation status of ductal cells. The expression of genes involved in hereditary polycystic diseases was determined by real-time, reverse-transcription polymerase chain reaction (RT-PCR). RESULTS We show that HNF-6 is expressed in the pancreatic duct epithelium throughout development and that, in the absence of HNF-6, duct morphogenesis is perturbed. Although development of the intercalated ducts is normal, cysts appear within the interlobular and intralobular ducts. This is associated with abnormal development of primary cilia at the apical pole of the duct cells and with reduced expression of a set of genes involved in polycystic diseases, namely those coding for HNF-1beta and for the cilium-associated proteins polyductin/fibrocystin and cystin. CONCLUSIONS We identify HNF-6 as the first transcriptional regulator of pancreatic duct development and reveal the existence of different regulatory mechanisms in distinct duct compartments. HNF-6 controls a network of genes involved in cilium formation and in hereditary polycystic diseases. Finally, HNF-6 deficiency represents a genetically defined model of pancreatic cystic disease.
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Affiliation(s)
- Christophe E Pierreux
- Hormone and Metabolic Research Unit, Université Catholique de Louvain and Institute of Cellular Pathology, Brussels, Belgium
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26
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Davenport JR, Yoder BK. An incredible decade for the primary cilium: a look at a once-forgotten organelle. Am J Physiol Renal Physiol 2005; 289:F1159-69. [PMID: 16275743 DOI: 10.1152/ajprenal.00118.2005] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Since the discovery that numerous proteins involved in mammalian disease localize to the basal bodies and cilia, these organelles have emerged from relative obscurity to the center of intense research efforts in an expanding number of disease- and developmental-related fields. Our understanding of the association between cilia and human disease has benefited substantially from the use of lower organisms such as Chlamydomonas and Caenorhabditis elegans and the availability of murine models and cell culture. These research endeavors led to the discovery that loss of normal ciliary function in mammals is responsible for cystic and noncystic pathology in the kidney, liver, brain, and pancreas, as well as severe developmental patterning abnormalities. In addition, the localization of proteins involved in rare human disorders such as Bardet-Biedl syndrome has suggested that cilia-related dysfunction may play a role in modern human epidemics such as hypertension, obesity, and diabetes. Although we have made great advances in demonstrating the importance of cilia over the past decade, the physiological role that this organelle plays in most tissues remains elusive. Research focused on addressing this issue will be of critical importance for a further understanding of how ciliary dysfunction can lead to such severe disease and developmental pathologies.
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Affiliation(s)
- James R Davenport
- Department of Cell Biology, University of Alabama at Birmingham, 35294, USA
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27
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Bae KT, Zhu F, Chapman AB, Torres VE, Grantham JJ, Guay-Woodford LM, Baumgarten DA, King BF, Wetzel LH, Kenney PJ, Brummer ME, Bennett WM, Klahr S, Meyers CM, Zhang X, Thompson PA, Miller JP. Magnetic Resonance Imaging Evaluation of Hepatic Cysts in Early Autosomal-Dominant Polycystic Kidney Disease: The Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease Cohort. Clin J Am Soc Nephrol 2005; 1:64-9. [PMID: 17699192 DOI: 10.2215/cjn.00080605] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objective of this study was to investigate the prevalence of hepatic cysts by age and gender in patients with early autosomal-dominant polycystic kidney disease (ADPKD) and to determine whether hepatic cyst volume is related to renal and renal cyst volumes by using magnetic resonance imaging (MRI). A total of 230 patients with ADPKD (94 men and 136 women) who were aged 15 to 46 yr and had relatively preserved renal function were studied. MRI images of the kidney and liver were obtained to measure renal, renal cyst, and hepatic cyst volumes. These volume measurements and hepatic cyst prevalence were compared in all patients and in subgroups on the basis of gender and age (15 to 24, 25 to 34, and 35 to 46 yr). The overall prevalence of hepatic cysts was 83%; the prevalence was 58, 85, and 94% in the sequential age groups and 85% in women and 79% in men. The prevalence was related directly to renal volume (chi2 = 4.30, P = 0.04) and to renal cyst volume (chi2 = 5.59, P = 0.02). The total hepatic cyst volume was significantly greater in women than in men (a logarithmic transformation mean of 5.27 versus 1.94 ml; P = 0.003). The average hepatic cyst volume was 0.25, 5.75, and 22.78 ml in sequential age groups. Hepatic cysts are evident in 94% of patients who are older than 35 yr and in 55% of individuals who are younger than 25 yr. Hepatic cysts are more prevalent and larger in total cyst volume in women than in men. Hepatic cyst prevalence and aggregate total hepatic cyst volume increased with age.
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Affiliation(s)
- Kyongtae T Bae
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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28
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Grantham JJ, Chapman AB, Torres VE. Volume Progression in Autosomal Dominant Polycystic Kidney Disease: The Major Factor Determining Clinical Outcomes. Clin J Am Soc Nephrol 2005; 1:148-57. [PMID: 17699202 DOI: 10.2215/cjn.00330705] [Citation(s) in RCA: 221] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autosomal dominant polycystic kidney disease (PKD) is a hereditary condition characterized by the progressive enlargement of innumerable renal cysts that contribute to life-altering morbidity early in the course of the disease. Evidence indicates that the rate of increase in kidney volume can be reliably measured by magnetic resonance or computed tomography imaging, thus providing objective means to judge the effectiveness of therapies that are targeted to the aberrant growth of renal tubules. It is now possible, therefore, to monitor the effectiveness of potential therapies on the signature abnormality in autosomal dominant PKD before irreversible damage has been done by the cysts. Evidence accumulated from human cross-sectional and longitudinal studies and longitudinal studies of PKD models in animals provide strong support for the view that reducing the rate of kidney volume enlargement will ameliorate the late-stage development of renal insufficiency.
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29
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Zhang Q, Davenport JR, Croyle MJ, Haycraft CJ, Yoder BK. Disruption of IFT results in both exocrine and endocrine abnormalities in the pancreas of Tg737(orpk) mutant mice. J Transl Med 2005; 85:45-64. [PMID: 15580285 DOI: 10.1038/labinvest.3700207] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
While relatively ignored for years as vestigial, cilia have recently become the focus of intense interest as organelles that result in severe pathologies when disrupted. Here, we further establish a connection between cilia dysfunction and disease by showing that loss of polaris (Tg737), an intraflagellar transport (IFT) protein required for ciliogenesis, causes abnormalities in the exocrine and endocrine pancreas of the Tg737(orpk) mouse. Pathology is evident late in gestation as dilatations of the pancreatic ducts that continue to expand postnatally. Shortly after birth, the acini become disorganized, undergo apoptosis, and are largely ablated in late stage pathology. In addition, serum amylase levels are elevated and carboxypeptidase is abnormally activated within the pancreas. Ultrastructural analysis reveals that the acini undergo extensive vacuolization and have numerous 'halo-granules' similar to that seen in induced models of pancreatitis resulting from duct obstruction. Intriguingly, although the acini are severely affected in Tg737(orpk) mutants, cilia and Tg737 expression are restricted to the ducts and islets and are not detected on acinar cells. Analysis of the endocrine pancreas in Tg737(orpk) mutants revealed normal differentiation and distribution of cell types in the islets. However, after fasting, mutant blood glucose levels are significantly lower than controls and when challenged in glucose tolerance tests, Tg737(orpk) mutants exhibited defects in glucose uptake. These findings are interesting in light of the recently proposed role for polaris, the protein encoded by the Tg737 gene, in the hedgehog pathway and hedgehog signaling in insulin production and glucose homeostasis.
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Affiliation(s)
- Qihong Zhang
- Department of Cell Biology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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30
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Boucher C, Sandford R. Autosomal dominant polycystic kidney disease (ADPKD, MIM 173900, PKD1 and PKD2 genes, protein products known as polycystin-1 and polycystin-2). Eur J Hum Genet 2004; 12:347-54. [PMID: 14872199 DOI: 10.1038/sj.ejhg.5201162] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited nephropathy affecting over 1:1000 of the worldwide population. It is a systemic condition with frequent hepatic and cardiovascular manifestations in addition to the progressive development of renal cysts that eventually result in loss of renal function in the majority of affected individuals. The diagnosis of ADPKD is typically made using renal imaging despite the identification of mutations in PKD1 and PKD2 that account for virtually all cases. Mutations in PKD1 are associated with more severe clinical disease and earlier onset of renal failure. Most PKD gene mutations are loss of function and a 'two-hit' mechanism has been demonstrated underlying focal cyst formation. The protein products of the PKD genes, the polycystins, form a calcium-permeable ion channel complex that regulates the cell cycle and the function of the renal primary cilium. Abnormal cilial function is now thought to be the primary defect in several types of PKD including autosomal recessive polycystic kidney disease and represents a novel and exciting mechanism underlying a range of human diseases.
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Affiliation(s)
- Catherine Boucher
- Department of Medical Genetics, Cambridge Institute for Medical Research, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2XY, UK
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31
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Brun M, Maugey-Laulom B, Eurin D, Didier F, Avni EF. Prenatal sonographic patterns in autosomal dominant polycystic kidney disease: a multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:55-61. [PMID: 15229917 DOI: 10.1002/uog.1098] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine whether a specific prenatal sonographic pattern can be identified for autosomal dominant polycystic kidney disease (ADPKD) and if so whether it would be helpful in orienting complementary analysis, properly counseling parents and adapting pregnancy management. METHODS A retrospective multicenter study was conducted in four prenatal diagnostic centers. The records of fetuses with a prenatal ultrasound examination revealing abnormal kidneys and with a final diagnosis of ADPKD were analyzed. Ultrasound analysis included: amount of amniotic fluid, bladder size, renal length, presence or absence of renal cysts and size of renal pelves, and was focused on parenchyma echogenicity and status of corticomedullary differentiation. Postnatal follow-up was reviewed. RESULTS Of the 27 patients included in the study, 25 had hyperechogenic renal cortex and 20 had hypoechogenic medulla resulting in increased corticomedullary differentiation (CMD). In six cases, the medulla was hyperechogenic leading to absent or decreased CMD. One patient had normal cortical echogenicity and CMD. Renal cysts were present during the prenatal period in four patients (at 22 weeks in one case and after 30 weeks in three cases). In 12 patients, the cysts appeared after birth (within the first 6 months of postnatal life in 10 cases and by the age of 1 year in two cases). Elevated blood pressure was observed in only two cases and moderate chronic renal failure in one case. CONCLUSION We have described the sonographic presentation in fetuses with ADPKD: moderately enlarged hyperechogenic kidneys with increased CMD. Although not specific to ADPKD, these findings should prompt familial screening. Other prenatal sonographic features (absent or decreased CMD and cortical cysts) are less frequent.
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Affiliation(s)
- M Brun
- Service de Radiologie A, Hôpital Pellegrin CHU, Bordeaux, France.
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Tee JB, Acott PD, McLellan DH, Crocker JFS. Phenotypic heterogeneity in pediatric autosomal dominant polycystic kidney disease at first presentation: a single-center, 20-year review. Am J Kidney Dis 2004; 43:296-303. [PMID: 14750095 DOI: 10.1053/j.ajkd.2003.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The presentation of autosomal dominant polycystic kidney disease (ADPKD) in childhood provides an insight into comorbidities and potential areas for interventions and investigation. METHODS Phenotypic heterogeneity at the time of first presentation was studied with respect to age of diagnosis, mode of presentation, parental inheritance pattern, renal function, associated hypertension, and hyperlipidemia. Fifty-five children (median age of presentation, 8.7 years; 27% < 1 year) with ADPKD from 44 families followed up between March 1983 and March 2003 were reviewed. The diagnosis was based on family history and ultrasound confirmation of cysts. Progression of renal disease was followed over the study period (mean duration of follow-up, 4.9 years). RESULTS A family history of ADPKD was known at presentation in 89%, which precipitated the screening diagnostic imaging in 59% of these children. Maternal inheritance was displayed in 51%, whereas 5% had no known family history of ADPKD. Bilateral renal findings were present in 78%. Hypertension (>95(th) percentile for age) was present in 22%, and hyperlipidemia was present in 54%. Renal function was not significantly diminished in 98% of patients with creatinine clearance > or =3rd percentile for age, and 7% had persistent proteinuria (>150 mg/d). No subjects had hepatic, splenic, or pancreatic cysts on ultrasound scan. A subpopulation of 10 patients had features of ADPKD dating back to prenatal ultrasound scans. All prenatal cases were characterized by bilateral renal findings, 90% had a known family history of ADPKD at the time of presentation, and 89% of these patients displayed maternal inheritance. Follow-up studies showed a persistence of hyperlipidemia despite pharmacotherapeutic treatment of hypertension, infrequent proteinuria, and sustained renal function in most patients. CONCLUSION The results of this study show that many children at the time of first presentation have a significant prevalence of modifiable risk factors: hypertension, proteinuria, and hyperlipidemia, in the face of normal renal function. The results also show a unique presentation existing in prenatal subjects.
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Affiliation(s)
- James B Tee
- Division of Pediatric Nephrology, Department of Pediatrics, Izaak Walton Killam Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
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Mosetti MA, Leonardou P, Motohara T, Kanematsu M, Armao D, Semelka RC. Autosomal dominant polycystic kidney disease: MR imaging evaluation using current techniques. J Magn Reson Imaging 2003; 18:210-5. [PMID: 12884334 DOI: 10.1002/jmri.10347] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine the MR imaging findings of autosomal dominant polycystic kidney disease using current imaging techniques. MATERIALS AND METHODS We reviewed our five-year experience with MR imaging of autosomal dominant polycystic kidney disease (ADPKD) to determine the spectrum of appearance of kidney disease, the occurrence of cysts in other abdominal organs, the size and number of cysts in the kidneys and other organs, and the association with other benign or malignant disease. Thirty patients (17 men and 13 women, age range 30 to 88 years old) with ADPKD were included in this study. All patients were examined by MR imaging including T2-weighted single-shot echo-train spin-echo and pre- and post-gadolinium chelate spoiled gradient-echo imaging. RESULTS All kidneys were involved with multiple, varying sized cysts scattered throughout the parenchyma. Giant renal cysts (>8 cm) were associated with pain in the only two patients who possessed them. Hemorrhage in renal cysts was observed in all kidneys with a heterogeneous pattern of involvement on non-contrast T1- and T2-weighted images, reflecting hemorrhage of varying age. The mean kidney size for the right kidney was 17.4 cm in length, 10.3 cm in transverse, and 9.4 cm in antero-posterior diameter (AP); and for the left kidney, 15.9 cm in the length, 9.3 cm in the transverse, and 9.3 cm in AP diameter. Other organs involved included the liver (22 patients), the pancreas (three patients), with two of the above-mentioned patients having both liver and pancreas cysts, and the spleen (one patient) who had both liver and splenic cysts. Massive liver involvement with large cysts was associated with abdominal pain. Malignant disease was present in five patients, including two patients with renal cell carcinoma, one with bladder cancer, one with lung cancer, and one patient with anal adenocarcinoma. Comparison of pre- and post-contrast T1-weighted images was essential to detect renal cancer. CONCLUSION All kidneys in patients with ADPKD had extensive, varying-sized cysts and in all cases some cysts showed evidence of hemorrhage. The liver was the second most common organ to be involved with cystic disease, in 73% of patients. Large cysts in the kidneys and liver were associated with abdominal pain.
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Affiliation(s)
- Maria Antonietta Mosetti
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina 27599-7510, USA
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Bergmann C, Senderek J, Sedlacek B, Pegiazoglou I, Puglia P, Eggermann T, Rudnik-Schöneborn S, Furu L, Onuchic LF, De Baca M, Germino GG, Guay-Woodford L, Somlo S, Moser M, Büttner R, Zerres K. Spectrum of mutations in the gene for autosomal recessive polycystic kidney disease (ARPKD/PKHD1). J Am Soc Nephrol 2003; 14:76-89. [PMID: 12506140 DOI: 10.1097/01.asn.0000039578.55705.6e] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Autosomal recessive polycystic kidney disease (ARPKD/PKHD1) is an important cause of renal-related and liver-related morbidity and mortality in childhood. Recently mutations in the PKHD1 gene on chromosome 6p21.1-p12 have been identified as the molecular cause of ARPKD. The longest continuous open reading frame (ORF) is encoded by a 67-exon transcript and predicted to yield a 4074-amino acid protein ("polyductin") of thus far unknown function. By now, a total of 29 different PKHD1 mutations have been described. This study reports mutation screening in 90 ARPKD patients and identifies mutations in 110 alleles making up a detection rate of 61%. Thirty-four of the detected mutations have not been reported previously. Two underlying mutations in 40 patients and one mutation in 30 cases are disclosed, and no mutation was detected on the remaining chromosomes. Mutations were found to be scattered throughout the gene without evidence of clustering at specific sites. About 45% of the changes were predicted to truncate the protein. All missense mutations were nonconservative, with the affected amino acid residues found to be conserved in the murine polyductin orthologue. One recurrent missense mutation (T36M) likely represents a mutational hotspot and occurs in a variety of populations. Two founder mutations (R496X and V3471G) make up about 60% of PKHD1 mutations in the Finnish population. Preliminary genotype-phenotype correlations could be established for the type of mutation rather than for the site of the individual mutation. All patients carrying two truncating mutations displayed a severe phenotype with perinatal or neonatal demise. PKHD1 mutation analysis is a powerful tool to establish the molecular cause of ARPKD in a given family. Direct identification of mutations allows an unequivocal diagnosis and accurate genetic counseling even in families displaying diagnostic challenges.
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Affiliation(s)
- Carsten Bergmann
- Institute of Human Genetics, Aachen University, Aachen, Germany.
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Demos TC, Posniak HV, Harmath C, Olson MC, Aranha G. Cystic lesions of the pancreas. AJR Am J Roentgenol 2002; 179:1375-88. [PMID: 12438020 DOI: 10.2214/ajr.179.6.1791375] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Terrence C Demos
- Department of Radiology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
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36
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Onuchic LF, Furu L, Nagasawa Y, Hou X, Eggermann T, Ren Z, Bergmann C, Senderek J, Esquivel E, Zeltner R, Rudnik-Schöneborn S, Mrug M, Sweeney W, Avner ED, Zerres K, Guay-Woodford LM, Somlo S, Germino GG. PKHD1, the polycystic kidney and hepatic disease 1 gene, encodes a novel large protein containing multiple immunoglobulin-like plexin-transcription-factor domains and parallel beta-helix 1 repeats. Am J Hum Genet 2002; 70:1305-17. [PMID: 11898128 PMCID: PMC447605 DOI: 10.1086/340448] [Citation(s) in RCA: 337] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2002] [Accepted: 02/27/2002] [Indexed: 11/04/2022] Open
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a severe form of polycystic kidney disease that presents primarily in infancy and childhood and that is characterized by enlarged kidneys and congenital hepatic fibrosis. We have identified PKHD1, the gene mutated in ARPKD. PKHD1 extends over > or =469 kb, is primarily expressed in human fetal and adult kidney, and includes a minimum of 86 exons that are variably assembled into a number of alternatively spliced transcripts. The longest continuous open reading frame encodes a 4,074-amino-acid protein, polyductin, that is predicted to have a single transmembrane (TM)-spanning domain near its carboxyl terminus, immunoglobulin-like plexin-transcription-factor domains, and parallel beta-helix 1 repeats in its amino terminus. Several transcripts encode truncated products that lack the TM and that may be secreted if translated. The PKHD1-gene products are members of a novel class of proteins that share structural features with hepatocyte growth-factor receptor and plexins and that belong to a superfamily of proteins involved in regulation of cell proliferation and of cellular adhesion and repulsion.
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MESH Headings
- Age of Onset
- Alternative Splicing/genetics
- Amino Acid Motifs
- Base Sequence
- Cell Adhesion Molecules/chemistry
- Chromosomes, Human, Pair 6/genetics
- DNA Mutational Analysis
- Exons/genetics
- Female
- Fetus/metabolism
- Gene Expression Profiling
- Gene Expression Regulation, Developmental
- Humans
- Immunoglobulins/chemistry
- Kidney/metabolism
- Male
- Molecular Sequence Data
- Nerve Tissue Proteins/chemistry
- Pedigree
- Polycystic Kidney, Autosomal Recessive/epidemiology
- Polycystic Kidney, Autosomal Recessive/genetics
- Protein Structure, Secondary
- Protein Structure, Tertiary
- Protein Transport
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, Cell Surface/chemistry
- Receptors, Cell Surface/genetics
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Affiliation(s)
- Luiz F. Onuchic
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Laszlo Furu
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Yasuyuki Nagasawa
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Xiaoying Hou
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Thomas Eggermann
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Zhiyong Ren
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Carsten Bergmann
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Jan Senderek
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Ernie Esquivel
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Raoul Zeltner
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Sabine Rudnik-Schöneborn
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Michael Mrug
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - William Sweeney
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Ellis D. Avner
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Klaus Zerres
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Lisa M. Guay-Woodford
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Stefan Somlo
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
| | - Gregory G. Germino
- Departments of Medicine and Genetics, Johns Hopkins University, Baltimore; Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven; Departments of Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham; Institute for Human Genetics, Technical University of Aachen, Aachen, Germany; and Department of Pediatrics, Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland
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