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Forero-Delgadillo JM, Ochoa V, Duque N, Restrepo JM, Londoño H, Nastasi-Catanese JA, Pachajoa H. New PAX2 Mutation Associated with Polycystic Kidney Disease: A Case Report. Clin Med Insights Pediatr 2021; 15:1179556521992354. [PMID: 33746522 PMCID: PMC7940718 DOI: 10.1177/1179556521992354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/04/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage renal disease in children. Diagnosis by genetic testing has proven challenging due to its genetic and phenotypic heterogeneity, as well as incomplete penetrance. We report a case on a 16-months old female with a history of renal cysts and a PAX2 mutation. CASE PRESENTATION The patient presented with a prenatal diagnosis of Potter sequence and a postnatal diagnosis of renal cysts. An ultrasound at 20 weeks gestation revealed right renal agenesis and possible left renal dysplasia. Post natal genetic analyses identified a novel mutation in PAX2. CONCLUSION Cystic kidney disease is often underdiagnosed due to its variable expressivity and wide range of clinical manifestations; PAX2 genetic screening should be considered for all patients with CAKUT.
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Affiliation(s)
| | - Vanessa Ochoa
- Pediatric Nephrology Fellow, Universidad Icesi-Fundación Valle de Lili, Cali, Colombia
| | - Natalia Duque
- Medical student, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | - Hernando Londoño
- Pediatric Nephrology Departament, Fundación Valle del Lili, Cali, Colombia
| | | | - Harry Pachajoa
- Clinical Genetics Department, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
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2
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Groopman EE, Povysil G, Goldstein DB, Gharavi AG. Rare genetic causes of complex kidney and urological diseases. Nat Rev Nephrol 2020; 16:641-656. [PMID: 32807983 PMCID: PMC7772719 DOI: 10.1038/s41581-020-0325-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 02/08/2023]
Abstract
Although often considered a single-entity, chronic kidney disease (CKD) comprises many pathophysiologically distinct disorders that result in persistently abnormal kidney structure and/or function, and encompass both monogenic and polygenic aetiologies. Rare inherited forms of CKD frequently span diverse phenotypes, reflecting genetic phenomena including pleiotropy, incomplete penetrance and variable expressivity. Use of chromosomal microarray and massively parallel sequencing technologies has revealed that genomic disorders and monogenic aetiologies contribute meaningfully to seemingly complex forms of CKD across different clinically defined subgroups and are characterized by high genetic and phenotypic heterogeneity. Investigations of prevalent genomic disorders in CKD have integrated genetic, bioinformatic and functional studies to pinpoint the genetic drivers underlying their renal and extra-renal manifestations, revealing both monogenic and polygenic mechanisms. Similarly, massively parallel sequencing-based analyses have identified gene- and allele-level variation that contribute to the clinically diverse phenotypes observed for many monogenic forms of nephropathy. Genome-wide sequencing studies suggest that dual genetic diagnoses are found in at least 5% of patients in whom a genetic cause of disease is identified, highlighting the fact that complex phenotypes can also arise from multilocus variation. A multifaceted approach that incorporates genetic and phenotypic data from large, diverse cohorts will help to elucidate the complex relationships between genotype and phenotype for different forms of CKD, supporting personalized medicine for individuals with kidney disease.
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Affiliation(s)
- Emily E Groopman
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gundula Povysil
- Institute for Genomic Medicine, Columbia University, New York, NY, USA
| | - David B Goldstein
- Institute for Genomic Medicine, Columbia University, New York, NY, USA
| | - Ali G Gharavi
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
- Institute for Genomic Medicine, Columbia University, New York, NY, USA.
- Center for Precision Medicine and Genomics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
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3
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Cocchi E, Nestor JG, Gharavi AG. Clinical Genetic Screening in Adult Patients with Kidney Disease. Clin J Am Soc Nephrol 2020; 15:1497-1510. [PMID: 32646915 PMCID: PMC7536756 DOI: 10.2215/cjn.15141219] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Expanded accessibility of genetic sequencing technologies, such as chromosomal microarray and massively parallel sequencing approaches, is changing the management of hereditary kidney diseases. Genetic causes account for a substantial proportion of pediatric kidney disease cases, and with increased utilization of diagnostic genetic testing in nephrology, they are now also detected at appreciable frequencies in adult populations. Establishing a molecular diagnosis can have many potential benefits for patient care, such as guiding treatment, familial testing, and providing deeper insights on the molecular pathogenesis of kidney diseases. Today, with wider clinical use of genetic testing as part of the diagnostic evaluation, nephrologists have the challenging task of selecting the most suitable genetic test for each patient, and then applying the results into the appropriate clinical contexts. This review is intended to familiarize nephrologists with the various technical, logistical, and ethical considerations accompanying the increasing utilization of genetic testing in nephrology care.
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Affiliation(s)
- Enrico Cocchi
- Division of Nephrology and Center for Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, New York
- Department of Pediatrics, Universita' degli Studi di Torino, Torino, Italy
| | - Jordan Gabriela Nestor
- Division of Nephrology and Center for Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, New York
| | - Ali G Gharavi
- Division of Nephrology and Center for Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, New York
- Insititute of Genomic Medicine, Columbia University, New York, New York
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4
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Denis D, Hugo J, Beylerian M, Ramtohul P, Aziz A, Matonti F, Lebranchu P. [Congenital abnormalities of the optic disc]. J Fr Ophtalmol 2019; 42:778-789. [PMID: 30935696 DOI: 10.1016/j.jfo.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
Congenital abnormalities of the optic disc are not uncommon in clinical practice and should be recognized. Size abnormalities of the optic disc include optic disc aplasia, hypoplasia, megalopapilla, and optic disc cupping in prematurity. Among congenital excavations of the optic disc head, morning glory disc anomaly and optic disc pit can be complicated by serous retinal detachment; the papillorenal disc is an association of bilateral optic disc cupping and renal hypoplasia which should be ruled out; optic disc coloboma is caused by an abnormal closure of the embryonic fissure and can be complicated by choroidal neovascularization and retinal detachment. Other abnormalities that will be discussed are congenital tilted disc syndrome, duplicity of the optic disc head, congenital pigmentation of the optic disc head and myelinated retinal nerve fibers. All of these abnormalities can be associated with syndromes and neurological diseases, as well as other potentially blinding ophthalmological defects which can be secondarily complicated by amblyopia, strabismus and nystagmus. Thus, they should be recognized in order to plan for appropriate follow-up.
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Affiliation(s)
- D Denis
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - J Hugo
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - M Beylerian
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Ramtohul
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - A Aziz
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - F Matonti
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Lebranchu
- Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000 Nantes, France
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Zhang L, Zhai SB, Zhao LY, Zhang Y, Sun BC, Ma QS. New PAX2 heterozygous mutation in a child with chronic kidney disease: a case report and review of the literature. BMC Nephrol 2018; 19:245. [PMID: 30241513 PMCID: PMC6151052 DOI: 10.1186/s12882-018-1044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We herein report a 3-year-old boy presented with chronic kidney disease (CKD) due to PAX2 missense mutation (C to G transversion at position 418 in exon 4). CASE PRESENTATION He attended our clinic with a 3-month history of foamy urine. Upon examination, he had reduced estimated glomerular filtration rate (GFR) and renal atrophy. Genetic investigations revealed that he has inherited a mutated PAX2 gene from his father, who had renal failure at the age of 20. We searched the literature and confirmed that this mutation site has not been reported by any other group before. CONCLUSIONS Although renal coloboma syndrome (RCS) with simultaneous kidney and eye involvement is the most common phenotype of PAX2 mutations, current literature supports that such mutations may have profuse clinical manifestations and renal hypoplasia is one distinct entity in the spectrum.
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Affiliation(s)
- Li Zhang
- Department of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, Jilin, 130021 China
| | - Shu-bo Zhai
- Department of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, Jilin, 130021 China
| | - Leng-yue Zhao
- Department of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, Jilin, 130021 China
| | - Yan Zhang
- Department of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, Jilin, 130021 China
| | - Bai-chao Sun
- Department of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, Jilin, 130021 China
| | - Qing-shan Ma
- Department of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, Jilin, 130021 China
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6
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Alkanderi S, Yates LM, Johnson SA, Sayer JA. Lessons learned from a multidisciplinary renal genetics clinic. QJM 2017; 110:453-457. [PMID: 28177086 DOI: 10.1093/qjmed/hcx030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Inherited renal disorders comprise a significant proportion of cases in both paediatric and adult nephrology services. Genetic advances have advanced rapidly while clinical models of care delivery have remained static. AIM To describe a cohort of patients attending a multidisciplinary renal genetics clinic and the insights gained from this experience. DESIGN AND METHODS A retrospective review of clinic cases and their molecular genetic diagnosis over a 5-year period. RESULTS We report details of 244 individuals including 80 probands who attended the clinic. The commonest reasons for referral was familial haematuria which accounted for 37.5% of cases and cystic kidney disease, accounting for 31% of cases. Eighteen probands had a known molecular genetic diagnosis and were referred for genetic counselling and screening of at risk relatives and management plans. About 62 probands and their families were referred for a precise molecular diagnosis and this was achieved in 26 cases (42%). The most frequent new genetic diagnoses were COL4A5 mutations underlying familial haematuria and familial end stage renal disease. The clinic also allowed for patients with rare renal syndromes to be reviewed, such as ciliopathy syndromes, allowing detailed phenotyping and often a precise molecular genetic diagnosis to be provided. CONCLUSIONS The integration of modern day genetics and genomics into multidisciplinary clinics often allows a precise diagnosis which benefits patients, their relatives and the clinicians providing care and future management.
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Affiliation(s)
- S Alkanderi
- Newcastle University, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - L M Yates
- Newcastle University, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
- Northern Genetics Service, International Centre for Life, Central Parkway, Newcastle NE1 3BZ, UK
| | - S A Johnson
- Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK
| | - J A Sayer
- Newcastle University, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
- Renal Services, Newcastle upon Tyne NHS Foundation Trust Hospitals, Newcastle upon Tyne NE7 7DN, UK
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Iwafuchi Y, Morioka T, Morita T, Yanagihara T, Oyama Y, Morisada N, Iijima K, Narita I. Diverse Renal Phenotypes Observed in a Single Family with a Genetic Mutation in Paired Box Protein 2. Case Rep Nephrol Dial 2016; 6:61-9. [PMID: 27226968 PMCID: PMC4870939 DOI: 10.1159/000445679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A common renal phenotype of paired box protein 2 (PAX2) mutations is renal coloboma syndrome. We report a single family with diverse renal phenotypes associated with PAX2 mutation. The proband presented steroid-resistant focal segmental glomerulosclerosis with optic coloboma, whereas his two sons showed severe renal hypoplasia with end-stage renal disease, with or without optic coloboma. In all three cases, a heterozygous PAX2 genetic mutation was identified (exon 2; NM_003987.3:c.76dupG, p.Val26Glyfs*28). Based on histopathological findings of the proband, we hypothesized that autophagic dysfunction was associated with the pathophysiology of the focal segmental glomerulosclerosis with PAX2 mutation. Detailed funduscopic examination - including the optic disc - might be useful for the diagnosis of renal anomalies associated with PAX2 mutation.
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Affiliation(s)
- Yoichi Iwafuchi
- Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Japan
| | - Tetsuo Morioka
- Department of Internal Medicine, Kidney Center, Shinrakuen Hospital, Kobe, Japan
| | - Takashi Morita
- Department of Pathology, Shinrakuen Hospital, Kobe, Japan
| | | | - Yuko Oyama
- Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Japan
| | - Naoya Morisada
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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