Diverse ancestry whole-genome sequencing association study identifies TBX5 and PTK7 as susceptibility genes for posterior urethral valves

Translational strategies to uncover the etiology of congenital anomalies of the kidney and urinary tract

While up to 50% of children requiring kidney replacement therapy have congenital anomalies of the kidney and urinary tract (CAKUT), they represent only a fraction of the total patient population with CAKUT. The extreme variability in clinical outcome underlines the fundamental need to devise personalized clinical management strategies for individuals with CAKUT. Better understanding of the pathophysiology of abnormal kidney and urinary tract development provides a framework for precise diagnoses and prognostication of patients, the identification of biomarkers and disease modifiers, and, thus, the development of personalized strategies for treatment. In this review, we provide a state-of-the-art overview of the currently known genetic causes, including rare variants in kidney and urinary tract development genes, genomic disorders, and common variants that have been attributed to CAKUT. Furthermore, we discuss the impact of environmental factors and their interactions with developmental genes in kidney and urinary tract malformations. Finally, we present multi-angle translational modalities to validate candidate genes and environmental factors and shed light on future strategies to better understand the molecular underpinnings of CAKUT.

Late Presentation of Posterior Urethral Valve in a Four-Year-Old Child With Subtle Voiding Symptoms: A Case Report

A four-year-old male child following an attack of acute pharyngitis was referred to the urology department as having mild voiding difficulty, where posterior urethral valve (PUV) was incidentally diagnosed. Urethrocystoscopy confirmed Type I PUV, which was successfully managed with transurethral laser ablation. This case underscores the importance of evaluating subtle pediatric urinary symptoms to prevent renal complications. Advances in imaging, surgical techniques, and monitoring strategies are critical for effective management. Early diagnosis and timely intervention remain essential to preserve renal and bladder function, emphasizing the need for vigilance in assessing pediatric urinary complaints.

The etiology of congenital obstructive uropathy: developmental and genetic perspectives

Congenital obstructive uropathy (COU) encompasses a heterogeneous group of anomalies arising during critical stages of fetal development, which are characterized by functional or structural obstruction of the urinary tract. This obstruction hampers normal urine flow, and the resulting urinary pressure build-up can damage the developing kidneys and bladder. COU pathogenesis is complex and its clinical outcomes are highly variable, ranging from asymptomatic ultrasonographic abnormalities to end-stage kidney disease. This review examines the developmental and genetic mechanisms underlying COU and the associated organ damage, with a focus on intrinsic, isolated forms. Although genetic studies have improved our understanding of the molecular pathways involved in urinary tract maldevelopment, most patients lack a genetic diagnosis. Hence, multiple etiologic factors appear at play, including (epi)genetic and environmental. Closing gaps in our knowledge of kidney and urinary tract development and their interdependency for normal function is essential for developing personalized care to ultimately improve patient outcomes.

Pathophysiology of Congenital Anomalies of the Kidney and Urinary Tract: A Comprehensive Review

Congenital anomalies of the kidney and urinary tract (CAKUT) represent a broad range of diseases with differing mechanisms, clinical presentations, and prognoses. With an estimated prevalence of between 4 and 60 per 10,000 births, CAKUT represents a sizable number of patients for pediatric and adult nephrologists as therapies have progressed, allowing longer life spans. Many CAKUT disorders are associated with genetic mutations, and with advances in genomic sequencing, these genes are being identified at an increasing rate. Understanding these mutations provides insight into these conditions' molecular mechanisms and pathophysiology. In this article, we discuss the epidemiology, presentation, and outcomes of CAKUT in addition to our current understanding of genetic and molecular mechanisms in these diseases.

A Genome-Wide Association Study into the Aetiology of Congenital Solitary Functioning Kidney

Congenital solitary functioning kidney (CSFK) is a birth defect that occurs in 1:1500 children and predisposes them to kidney injury. Its aetiology is likely multifactorial. In addition to known monogenic causes and environmental risk factors, common genetic variation may contribute to susceptibility to CSFK. We performed a genome-wide association study among 452 patients with CSFK and two control groups of 669 healthy children and 5363 unaffected adults. Variants in two loci reached the genome-wide significance threshold of 5 × 10-8, and variants in 30 loci reached the suggestive significance threshold of 1 × 10-5. Of these, an identified locus with lead single nucleotide variant (SNV) rs140804918 (odds ratio 3.1, p-value = 1.4 × 10-8) on chromosome 7 was most promising due to its close proximity to HGF, a gene known to be involved in kidney development. Based on their known molecular functions, both KCTD20 and STK38 could explain the suggestive significant association with lead SNV rs148413365 on chromosome 6. Our findings need replication in an independent cohort of CSFK patients before they can be established definitively. However, our analysis suggests that common variants play a role in CSFK aetiology. Future research could enhance our understanding of the molecular mechanisms involved.