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Gefen AM, Sethna CB, Cil O, Perwad F, Schoettler M, Michael M, Angelo JR, Safdar A, Amlie-Wolf L, Hunley TE, Ellison JS, Feig D, Zaritsky J. Genetic testing in children with nephrolithiasis and nephrocalcinosis. Pediatr Nephrol 2023; 38:2615-2622. [PMID: 36688940 PMCID: PMC11071637 DOI: 10.1007/s00467-023-05879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Diagnosing genetic kidney disease has become more accessible with low-cost, rapid genetic testing. The study objectives were to determine genetic testing diagnostic yield and examine predictors of genetic diagnosis in children with nephrolithiasis/nephrocalcinosis (NL/NC). METHODS This retrospective multicenter cross-sectional study was conducted on children ≤ 21 years old with NL/NC from pediatric nephrology/urology centers that underwent the Invitae Nephrolithiasis Panel 1/1/2019-9/30/2021. The diagnostic yield of the genetic panel was calculated. Bivariate and multiple logistic regression were performed to assess for predictors of positive genetic testing. RESULTS One hundred and thirteen children (83 NL, 30 NC) from 7 centers were included. Genetic testing was positive in 32% overall (29% NL, 40% NC) with definite diagnoses (had pathogenic variants alone) made in 11.5%, probable diagnoses (carried a combination of pathogenic variants and variants of uncertain significance (VUS) in the same gene) made in 5.4%, and possible diagnoses (had VUS alone) made in 15.0%. Variants were found in 28 genes (most commonly HOGA1 in NL, SLC34A3 in NC) and 20 different conditions were identified. Compared to NL, those with NC were younger and had a higher proportion with developmental delay, hypercalcemia, low serum bicarbonate, hypophosphatemia, and chronic kidney disease. In multivariate analysis, low serum bicarbonate was associated with increased odds of genetic diagnosis (β 2.2, OR 8.7, 95% CI 1.4-54.7, p = 0.02). CONCLUSIONS Genetic testing was high-yield with definite, probable, or possible explanatory variants found in up to one-third of children with NL/NC and shows promise to improve clinical practice. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ashley M Gefen
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 269-01 76th Ave, Queens, NY, 11040, USA.
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 269-01 76th Ave, Queens, NY, 11040, USA
| | - Onur Cil
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Farzana Perwad
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Megan Schoettler
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Mini Michael
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Joseph R Angelo
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Adnan Safdar
- Division of Nephrology, Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - Louise Amlie-Wolf
- Precision Medicine/Genetic Testing Stewardship Program, Nemours Children's Health, Delaware Valley, Wilmington, DE, USA
| | - Tracy E Hunley
- Division of Nephrology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jonathan S Ellison
- Division of Pediatric Urology, Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Feig
- Division of Nephrology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Joshua Zaritsky
- Division of Nephrology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA
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Liu APY, Shing MMK, Yuen HL, Li CH, Ling SC, Luk CW, Ha SY, Li CK, Chan GCF, Tsui K, Gajjar A, Li C, Srivastava D, Broniscer A, Wetmore C, Kun LE, Merchant TE, Ellison DW, Orr B, Boop FA, Paul Klimo J, Ross JD, Robison LL, Armstrong GT, Walker D, Chu T, Shah A, Wilne S, Coleman M, Jaque FAM, Muthappan M, Law AJJ, Shing MMK, Chan GCF, Yuen HL, Lee RCH, Ling SC, Luk CW, Ha SY, Li CK, Mang OWS, Ngan RKC, Alston R, Estlin E, McCabe M, Birch J, Gattamaneni R, Kamaly-Asl I, Estlin E, Kamaly-Asl I, McCabe M, Birch J, Gattamaneni R, Alston R, Alston R, Estlin E, McCabe M, Gattamaneni R, Birch J, Kamaly-Asl I, Bendel A, Pond D, Woehrer A, Azizi AA, Heumesser R, Hackl M, Hainfellner JA, Dorfer C, Czech T, Chocholous M, Slavc I, Haberler C, Hami H, Ayoujil A, Habib F, Soulaymani A, Mokhtari A, Quyou A, Lim AHJ, Chan MY, Tan AM, Soh SY, Garba SM, Hami H, Zaki HM, Soulaymani A, Nouhou H, Quyou A, Owens-Pickle E, Smith A, Green AL, Schoettler M, Bandopadhayay P, Sauer N, Manley PE, Chi SN, Rodriguez-Galindo C, Kieran MW, Ribeiro K. EPIDEMIOLOGY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Seed WA, Noble MI, Walker JM, Miller GA, Pidgeon J, Redwood D, Wanless R, Franz MR, Schoettler M, Schaefer J. Relationships between beat-to-beat interval and the strength of contraction in the healthy and diseased human heart. Circulation 1984; 70:799-805. [PMID: 6488494 DOI: 10.1161/01.cir.70.5.799] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Twenty-six adult patients, classified by clinical and catheter criteria into groups of those with normal and abnormal left ventricular function, were studied during cardiac catheterization. Right heart pacing was established, and left ventricular dP/dt was measured with end-catheter manometers. By varying the interval preceding a test beat after periods of steady pacing it was confirmed that recovery of left ventricular mechanical function (maximum dP/dt) occurs approximately 800 msec (optimum interval) after a beat. The augmentation of maximum dP/dt of the first 2 beats after an extrasystole, each spaced at the optimum interval, was also studied; the amount of potentiation was varied by alterations in extrasystolic interval. Potentiation decayed from the first to the second postextrasystolic beat with a ratio that was fixed in each individual patient. The ratio (recirculation fraction) was higher in patients with normal than in those with abnormal left ventricular function (mean +/- SD 0.52 +/- 0.10 vs 0.37 +/- 0.11, p less than .005). There was an inverse relationship between this ratio and the degree of potentiation of the first postextrasystolic beat (r = .80, p less than .001). We postulate a disturbance of excitation-contraction coupling mechanisms to explain these effects.
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