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Tasic V, Edvardsson VO, Preka E, Prikhodina L, Stefanidis CJ, Topaloglu R, Shtiza D, Sarkissian A, Mueller-Sacherer T, Fataliyeva R, Kazyra I, Levtchenko E, Pokrajac D, Roussinov D, Milošević D, Elia A, Seeman T, Faerch M, Vainumae I, Kataja J, Tsimaratos M, Rtskhiladze I, Hoyer PF, Reusz G, Awan A, Lotan D, Peruzzi L, Nigmatullina N, Beishebaeva N, Jeruma E, Jankauskiene A, Niel O, Said-Conti V, Ciuntu A, Pavićević S, Oosterveld M, Bjerre A, Tkaczyk M, Teixeira A, Lungu AC, Tsygin A, Stojanović V, Podracka L, Kersnik Levart T, Espino-Hernández M, Brandström P, Sparta G, Alpay H, Ivanov D, Dudley J, Khamzaev K, Haffner D, Ehrich J. Diversity of kidney care referral pathways in national child health systems of 48 European countries. Front Pediatr 2024; 12:1327422. [PMID: 38292210 PMCID: PMC10825019 DOI: 10.3389/fped.2024.1327422] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. Methods In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. Results The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Conclusion Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.
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Affiliation(s)
- Velibor Tasic
- Medical School, University Children’s Hospital, Skopje, North Macedonia
| | - Vidar O. Edvardsson
- Iceland Children’s Medical Center, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Evgenia Preka
- Paediatric Nephrology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Larisa Prikhodina
- Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Diamant Shtiza
- Department of Pediatric Nephrology, University Hospital Centre “Mother Teresa”, Tirana, Albania
| | - Ashot Sarkissian
- Arabkir Joint Medical Centre, Yerevan State Medical University, Yerevan, Armenia
| | - Thomas Mueller-Sacherer
- Department of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Rena Fataliyeva
- Department of Pediatric Nephrology, Children’s Hospital, Baku, Azerbaijan
| | - Ina Kazyra
- 1st Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Elena Levtchenko
- Department of Pediatrics & Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Danka Pokrajac
- Department of Pediatric Nephrology, University Children’s Hospital, Sarajevo, Bosnia and Herzegovina
| | - Dimitar Roussinov
- Nephrology and Hemodialysis Clinic, University of Sofia, Sofia, Bulgaria
| | - Danko Milošević
- Pediatric Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Avraam Elia
- Department of Paediatrics, Archbishop Makarios III Hospital, Nicosia, Cyprus
| | - Tomas Seeman
- Department of Pediatrics, 2nd Medical Faculty, Charles University Prague, Prague, Czech Republic
| | - Mia Faerch
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Inga Vainumae
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Janne Kataja
- Department of Paediatrics and Adolescents Medicine, Turku University Hospital, Turku, Finland
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | | | - Peter F. Hoyer
- Department of Pediatric Nephrology, University Hospital Essen, Essen, Germany
| | - George Reusz
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Atif Awan
- Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Danny Lotan
- Division of Pediatric Nephrology, Sheba Medical Center, Edmond and Lily Children’s Hospital, Tel Hashomer, Israel
| | - Licia Peruzzi
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita University Children's Hospital, Turin, Italy
| | - Nazim Nigmatullina
- Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan
| | - Nasira Beishebaeva
- Department of Nephrology, National Center of Maternity and Childhood Welfare under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Edite Jeruma
- Bērnu Slimību Klīnika, Nefroloģijas Profila Virsārste, Riga, Latvia
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Olivier Niel
- Pediatric Nephrology Unit, Department of Pediatrics, Centre Hospitalier de Luxembourg, Luxembourg, Luxemburg
| | - Valerie Said-Conti
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Angela Ciuntu
- Nephrology Unit, National Institute of Health Care for Mother and Child, Chisinau, Moldova
| | - Snežana Pavićević
- Clinical Center of Montenegro, Institute for Sick Children, Podgorica, Montenegro
| | - Michiel Oosterveld
- Department of Paediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Anna Bjerre
- Department of Pediatric and Adolescent Medicine, University Hospital of Oslo, Oslo, Norway
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Ana Teixeira
- Pediatric Nephrology Division, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Adrian C. Lungu
- Pediatric Nephrology, Fundeni Clincal Institute, Bucharest, Romania
| | - Alexey Tsygin
- National Medical and Research Centre for Children's Health, Moscow, Russia
| | - Vesna Stojanović
- Pediatric Intensive Care Unit, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Ludmila Podracka
- Department of Pediatrics, Comenius University, Bratislava, Slovakia
| | - Tanja Kersnik Levart
- Pediatric Nephrology Department, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Per Brandström
- Pediatric Uro-Nephrologic Center, Department of Pediatrics Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giuseppina Sparta
- Department of Pediatric Nephrology, University Children’s Hospital, Zurich, Switzerland
| | - Harika Alpay
- Division of Pediatric Nephrology, Marmara University, Istanbul, Turkey
| | - Dmytro Ivanov
- Nephrology and RRT Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Children's Hospital, Bristol, United Kingdom
| | - Komiljon Khamzaev
- Department of Pediatric Nephrology and Hemodialysis, Tashkent Pediatric Medical Institute, National Children's Medical Center, Tashkent, Uzbekistan
| | - Dieter Haffner
- Children’s Hospital, Hannover Medical School, Hannover, Germany
| | - Jochen Ehrich
- Children’s Hospital, Hannover Medical School, Hannover, Germany
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Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, Nozu K, Kamei K, Fujinaga S, Iijima K, Kang HG, Sinha R, Basu B, Morello W, Montini G, Waters A, Boyer O, Yıldırım ZY, Yel S, Dursun İ, McCarthy HJ, Vivarelli M, Prikhodina L, Besouw MTP, Chan EYH, Huang W, Kemper MJ, Loos S, Prestidge C, Wong W, Zlatanova G, Ehren R, Weber LT, Chehade H, Hooman N, Tkaczyk M, Stańczyk M, Miligkos M, Tullus K. Corrigendum to "A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants." Kidney Int. 2023;103:962-972. Kidney Int 2024; 105:213-214. [PMID: 38182294 DOI: 10.1016/j.kint.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Affiliation(s)
| | - Daniela Iancu
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Alexey Tsygin
- National Medical Research Centre of Children's Health, Moscow, Russia
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Aoife Waters
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hôpital Necker Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Zeynep Yürük Yıldırım
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hugh J McCarthy
- Department of Nephrology, Sydney Children's Hospitals Network & Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Martine T P Besouw
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Markus J Kemper
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | | | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | - Galia Zlatanova
- Department of Nephrology and Dialysis University Pediatric Hospital "Prof. Ivan Mitev", Department of Pediatrics Medical University, Sofia, Bulgaria
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hassib Chehade
- Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, Switzerland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Michael Miligkos
- Second Department of Pediatrics, University of Athens School of Medicine and P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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3
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Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, Nozu K, Kamei K, Fujinaga S, Iijima K, Sinha R, Basu B, Morello W, Montini G, Waters A, Boyer O, Yıldırım ZY, Yel S, Dursun İ, McCarthy HJ, Vivarelli M, Prikhodina L, Besouw MTP, Chan EYH, Huang W, Kemper MJ, Loos S, Prestidge C, Wong W, Zlatanova G, Ehren R, Weber LT, Chehade H, Hooman N, Tkaczyk M, Stańczyk M, Miligkos M, Tullus K. A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants. Kidney Int 2023; 103:962-972. [PMID: 36898413 DOI: 10.1016/j.kint.2023.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023]
Abstract
While 44-83% of children with steroid-resistant nephrotic syndrome (SRNS) without a proven genetic cause respond to treatment with a calcineurin inhibitor (CNI), current guidelines recommend against the use of immunosuppression in monogenic SRNS. This is despite existing evidence suggesting that remission with CNI treatment is possible and can improve prognosis in some cases of monogenic SRNS. Herein, our retrospective study assessed response frequency, predictors of response and kidney function outcomes among children with monogenic SRNS treated with a CNI for at least three months. Data from 203 cases (age 0-18 years) were collected from 37 pediatric nephrology centers. Variant pathogenicity was reviewed by a geneticist, and 122 patients with a pathogenic and 19 with a possible pathogenic genotype were included in the analysis. After six months of treatment and at last visit, 27.6% and 22.5% of all patients respectively, demonstrated partial or full response. Achievement of at least partial response at six months of treatment conferred a significant reduction in kidney failure risk at last follow-up compared to no response (hazard ratio [95% confidence interval] 0.25, [0.10-0.62]). Moreover, risk of kidney failure was significantly lower when only those with a follow-up longer than two years were considered (hazard ratio 0.35, [0.14-0.91]). Higher serum albumin level at CNI initiation was the only factor related to increased likelihood of significant remission at six months (odds ratio [95% confidence interval] 1.16, [1.08-1.24]). Thus, our findings justify a treatment trial with a CNI also in children with monogenic SRNS.
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Affiliation(s)
| | - Daniela Iancu
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Alexey Tsygin
- National Medical Research Centre of Children's Health, Moscow, Russia
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Aoife Waters
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hôpital Necker Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Zeynep Yürük Yıldırım
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hugh J McCarthy
- Department of Nephrology, Sydney Children's Hospitals Network & Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Martine T P Besouw
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Markus J Kemper
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | | | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | - Galia Zlatanova
- Department of Nephrology and Dialysis University Pediatric Hospital "Prof. Ivan Mitev", Department of Pediatrics Medical University, Sofia, Bulgaria
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hassib Chehade
- Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, Switzerland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Michael Miligkos
- Second Department of Pediatrics, University of Athens School of Medicine and P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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4
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Marlais M, Wlodkowski T, Printza N, Kronsteiner D, Krisam R, Sauer L, Aksenova M, Ashoor I, Awan A, Bacchetta J, Balasubramanian R, Basu B, Bekassy Z, Boyer O, Chan EYH, Csaicsich D, Decramer S, Dorresteijn E, Drozynska-Duklas M, Eid LA, Espinosa L, Ferraris V, Flögelová H, Forero-Delgadillo J, Gianviti A, Gracchi V, González ML, Hansen M, Hattori M, Hong X, Hooman N, Ivanov D, Kang HG, Karava V, Kazyra I, Lungu A, Marks S, Maxted A, Moczulska A, Müller R, Nastausheva T, Parolin M, Pecoraro C, Principi I, Sanchez-Kazi C, Saygili S, Schild R, Shenoy M, Sinha R, Spizzirri AP, Stack M, Szczepanska M, Tsygin A, Tzeng J, Urbonas V, Zapata C, Zieg J, Schaefer F, Vivarelli M, Tullus K. Clinical Factors and Adverse Kidney Outcomes in Children With Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Kidney Dis 2023; 81:119-122. [PMID: 35810826 DOI: 10.1053/j.ajkd.2022.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nikoleta Printza
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Regina Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Sauer
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Marina Aksenova
- Y. Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isa Ashoor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Atif Awan
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Biswanath Basu
- Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata, India
| | | | - Olivia Boyer
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | | | - Dagmar Csaicsich
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria
| | - Stéphane Decramer
- Pediatric Nephrology and Internal Medicine, CHU Purpan, Toulouse, France
| | | | | | - Loai Akram Eid
- Pediatric Nephrology, Dubai Medical College & Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Laura Espinosa
- Paediatric Nephrology Department, University Hospital La Paz, Madrid, Spain
| | | | - Hana Flögelová
- Department of Paediatrics, Faculty of Medicine, Palacky University, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | | | - Valentina Gracchi
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Beatrix Children's Hospital, Groningen, The Netherlands
| | | | - Matthias Hansen
- KfH Kidney Center for Children and Adolescents, Frankfurt, Germany
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Xu Hong
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Nakysa Hooman
- Aliasghar Children's Hospital, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Dmytro Ivanov
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Vasiliki Karava
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ina Kazyra
- Belarus State Medical University, Minsk, Belarus
| | - Adrian Lungu
- Pediatric Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Stephen Marks
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew Maxted
- Nottingham Children's Hospital Renal and Urology Unit, Nottingham, United Kingdom
| | - Anna Moczulska
- Jagiellonian University Medical College of Krakow, Krakow, Poland
| | - Rebekka Müller
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mattia Parolin
- Pediatric Nephrology, Dialysis and Transplantation Unit, Woman's and Child's Health Department, University Hospital of Padova, Padova, Italy
| | | | - Iliana Principi
- Department of Nephrology, Hospital Pediátrico Humberto J Notti, Mendoza, Argentina
| | | | - Seha Saygili
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Raphael Schild
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Ana Paula Spizzirri
- Nephrology Department, Hospital de Niños "Superiora Sor Maria Ludovica," La Plata, Argentina
| | - Maria Stack
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alexey Tsygin
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland; National Medical Research Center for Children's Health, Moscow, Russia
| | - Julia Tzeng
- Valley Children's Healthcare, Madera, California
| | - Vaidotas Urbonas
- Vilnius University Clinic for Children's Diseases, Vilnius, Lithuania
| | - Carlos Zapata
- Hospital Infantil Universitario "Rafael Henao Toro," Manizales, Colombia
| | - Jakub Zieg
- Department of Paediatrics, Second Medical Faculty, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kjell Tullus
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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5
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Trautmann A, Seide S, Lipska-Ziętkiewicz BS, Ozaltin F, Szczepanska M, Azocar M, Jankauskiene A, Zurowska A, Caliskan S, Saeed B, Morello W, Emma F, Litwin M, Tsygin A, Fomina S, Wasilewska A, Melk A, Benetti E, Gellermann J, Stajic N, Tkaczyk M, Baiko S, Prikhodina L, Csaicsich D, Medynska A, Krisam R, Breitschwerdt H, Schaefer F. Outcomes of steroid-resistant nephrotic syndrome in children not treated with intensified immunosuppression. Pediatr Nephrol 2022; 38:1499-1511. [PMID: 36315273 PMCID: PMC10060323 DOI: 10.1007/s00467-022-05762-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the current PodoNet registry analysis was to evaluate the outcome of steroid-resistant nephrotic syndrome (SRNS) in children who were not treated with intensified immunosuppression (IIS), focusing on the potential for spontaneous remission and the role of angiotensin blockade on proteinuria reduction. METHODS Ninety-five pediatric patients who did not receive any IIS were identified in the PodoNet Registry. Competing risk analyses were performed on 67 patients with nephrotic-range proteinuria at disease onset to explore the cumulative rates of complete or partial remission or progression to kidney failure, stratified by underlying etiology (genetic vs. non-genetic SRNS). In addition, Cox proportional hazard analysis was performed to identify factors predicting proteinuria remission. RESULTS Eighteen of 31 (58.1%) patients with non-genetic SRNS achieved complete remission without IIS, with a cumulative likelihood of 46.2% at 1 year and 57.7% at 2 years. Remission was sustained in 11 children, and only two progressed to kidney failure. In the genetic subgroup (n = 27), complete resolution of proteinuria occurred very rarely and was never sustained; 6 (21.7%) children progressed to kidney failure at 3 years. Almost all children (96.8%) received proteinuria-lowering renin-angiotensin-aldosterone system (RAAS) antagonist treatment. On antiproteinuric treatment, partial remission was achieved in 7 of 31 (22.6%) children with non-genetic SRNS and 9 of 27 children (33.3%) with genetic SRNS. CONCLUSION Our results demonstrate that spontaneous complete remission can occur in a substantial fraction of children with non-genetic SRNS and milder clinical phenotype. RAAS blockade increases the likelihood of partial remission of proteinuria in all forms of SRNS. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Agnes Trautmann
- Division of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Beata S Lipska-Ziętkiewicz
- Rare Diseases Centre and Clinical Genetics Unit, Department of Biology and Medical Genetics, Medical University of Gdansk, Gdansk, Poland
| | - Fatih Ozaltin
- Department of Pediatric Nephrology, Nephrogenetics Laboratory and Center for Biobanking and Genomics, Hacettepe University, Ankara, Turkey
| | - Maria Szczepanska
- Department of Pediatrics, School of Medicine With the Division of Dentistry, Zabrze, Poland
| | - Marta Azocar
- Pediatric Nephrology, Hospital Luis Calvo Mackenna-Facultad de Medicina Universidad de Chile, Santiago de, Chile
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Alexandra Zurowska
- Department of Pediatrics, Medical University of Gdansk, Nephrology & Hypertension, Gdansk, Poland
| | - Salim Caliskan
- Pediatric Nephrology Department, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bassam Saeed
- Farah Association for Child With Kidney Disease in Syria, Damascus, Syria
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Emma
- Department of Pediatric Subspecialties, Nephrology and Dialysis Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Mieczyslaw Litwin
- Department of Pediatric Nephrology, The Children's Memorial Health Center, Warsaw, Poland
| | - Alexey Tsygin
- National Medical and Research Center for Children's Health, Moscow, Russia
| | - Svitlana Fomina
- Department of Pediatric Nephrology, State Institution "Institute of Nephrology of NAMS of Ukraine", Kyiv, Ukraine
| | - Anna Wasilewska
- Department of Pediatric Nephrology, University Hospital, Bialystok, Poland
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Jutta Gellermann
- Clinic for Pediatric Nephrology, Charite Hospital, Berlin, Germany
| | - Natasa Stajic
- Department of Pediatric Nephrology, Institute of Mother and Healthcare of Serbia, Belgrade, Serbia
| | - Marcin Tkaczyk
- Pediatric Nephrology Division, Polish Mothers Memorial Hospital Research Institute, Lodz, Poland
| | - Sergey Baiko
- National Center for Pediatric Nephrology and Renal Replacement Therapy, Belarusian State Medical University, Minsk, Belarus
| | - Larisa Prikhodina
- Division of Inherited & Acquired Kidney Diseases, Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Dagmar Csaicsich
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Anna Medynska
- Department of Pediatric Nephrology, Wroclaw Medical University, Wroclaw, Poland
| | - Regina Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Heike Breitschwerdt
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
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6
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Lopez-Garcia SC, Emma F, Walsh SB, Fila M, Hooman N, Zaniew M, Bertholet-Thomas A, Colussi G, Burgmaier K, Levtchenko E, Sharma J, Singhal J, Soliman NA, Ariceta G, Basu B, Murer L, Tasic V, Tsygin A, Decramer S, Gil-Peña H, Koster-Kamphuis L, La Scola C, Gellermann J, Konrad M, Lilien M, Francisco T, Tramma D, Trnka P, Yüksel S, Caruso MR, Chromek M, Ekinci Z, Gambaro G, Kari JA, König J, Taroni F, Thumfart J, Trepiccione F, Winding L, Wühl E, Ağbaş A, Belkevich A, Vargas-Poussou R, Blanchard A, Conti G, Boyer O, Dursun I, Pınarbaşı AS, Melek E, Miglinas M, Novo R, Mallett A, Milosevic D, Szczepanska M, Wente S, Cheong HI, Sinha R, Gucev Z, Dufek S, Iancu D, Kleta R, Schaefer F, Bockenhauer D. Treatment and long-term outcome in primary distal renal tubular acidosis. Nephrol Dial Transplant 2020; 34:981-991. [PMID: 30773598 DOI: 10.1093/ndt/gfy409] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary distal renal tubular acidosis (dRTA) is a rare disorder, and we aimed to gather data on treatment and long-term outcome. METHODS We contacted paediatric and adult nephrologists through European professional organizations. Responding clinicians entered demographic, biochemical, genetic and clinical data in an online form. RESULTS Adequate data were collected on 340 patients (29 countries, female 52%). Mutation testing had been performed on 206 patients (61%); pathogenic mutations were identified in 170 patients (83%). The median (range) presentation age was 0.5 (0-54) years and age at last follow-up was 11.0 (0-70.0) years. Adult height was slightly below average with a mean (SD score) of -0.57 (±1.16). There was an increased prevalence of chronic kidney disease (CKD) Stage ≥2 in children (35%) and adults (82%). Nephrocalcinosis was reported in 88%. Nephrolithiasis was more common with SLC4A1 mutations (42% versus 21%). Thirty-six percent had hearing loss, particularly in ATP6V1B1 (88%). The median (interquartile range) prescribed dose of alkali (mEq/kg/day) was 1.9 (1.2-3.3). Adequate metabolic control (normal plasma bicarbonate and normocalciuria) was achieved in 158 patients (51%), more commonly in countries with higher gross domestic product (67% versus 23%), and was associated with higher height and estimated glomerular filtration rate. CONCLUSION Long-term follow-up from this large dRTA cohort shows an overall favourable outcome with normal adult height for most and no patient with CKD Stage 5. However, 82% of adult patients have CKD Stages 2-4. Importance of adequate metabolic control was highlighted by better growth and renal function but was achieved in only half of patients.
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Affiliation(s)
- Sergio Camilo Lopez-Garcia
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Nephrology, University College London, London, UK
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Stephen B Walsh
- Centre for Nephrology, University College London, London, UK
| | - Marc Fila
- Pediatric Nephrology-CHU Arnaud de Villeneuve, Montpellier University Hospital, Montpellier, France
| | - Nakysa Hooman
- Ali-Asghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | | | | | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital of Cologne, Cologne, Germany
| | | | | | | | - Neveen A Soliman
- Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Gema Ariceta
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Biswanath Basu
- Division of Pediatric Nephrology, NRS Medical College, Kolkata, India
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliera & University of Padova, Padova, Italy
| | - Velibor Tasic
- University Children's Hospital, Medical School, Skopje, Macedonia
| | - Alexey Tsygin
- National Medical and Research Centre for Children's Health, Moscow, Russia
| | - Stéphane Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Nephrologie Pediatrique, Hopital des Enfants, Centre De Reference des Maladies Rénales Rares du Sud Ouest, Toulouse, France
| | | | | | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | - Marc Lilien
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - Despoina Tramma
- Fourth Pediatric Department, Aristotle University, Thessaloniki, Greece
| | - Peter Trnka
- Lady Cilento Children's Hospital, Brisbane, Australia.,School of Medicine, the University of Queensland, Brisbane, Australia
| | - Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Maria Rosa Caruso
- Nephrology Unit Azienda Ospedaliera, Papa Giovani XXIII, Bergamo, Italy
| | | | - Zelal Ekinci
- Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Giovanni Gambaro
- Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence and Pediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jens König
- University Children's Hospital, Münster, Germany
| | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Louise Winding
- Pediatric Department, Lillebaelt Hospital Kolding, Kolding, Denmark
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ayşe Ağbaş
- Haseki Education and Research Hospital, Istanbul, Turkey
| | | | - Rosa Vargas-Poussou
- Department of Genetics, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Blanchard
- Department of Genetics, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Giovanni Conti
- Pediatric Nephrology Unit, AOU Policlinic G Martino, Messina, Italy
| | | | - Ismail Dursun
- Faculty of Medicine, Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | - Ayşe Seda Pınarbaşı
- Faculty of Medicine, Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | | | - Marius Miglinas
- Nephrology Centre, Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | | | - Andrew Mallett
- School of Medicine, the University of Queensland, Brisbane, Australia.,Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | - Sarah Wente
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Hae Il Cheong
- Department of Pediatrics, Seoul University Children's Hospital, Seoul, Korea
| | | | - Zoran Gucev
- Medical School, University Children's Hospital, Skopje, Macedonia
| | - Stephanie Dufek
- Centre for Nephrology, University College London, London, UK
| | - Daniela Iancu
- Centre for Nephrology, University College London, London, UK
| | | | - Robert Kleta
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Nephrology, University College London, London, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Detlef Bockenhauer
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Nephrology, University College London, London, UK
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7
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Hohenfellner K, Rauch F, Ariceta G, Awan A, Bacchetta J, Bergmann C, Bechtold S, Cassidy N, Deschenes G, Elenberg E, Gahl WA, Greil O, Harms E, Herzig N, Hoppe B, Koeppl C, Lewis MA, Levtchenko E, Nesterova G, Santos F, Schlingmann KP, Servais A, Soliman NA, Steidle G, Sweeney C, Treikauskas U, Topaloglu R, Tsygin A, Veys K, v. Vigier R, Zustin J, Haffner D. Management of bone disease in cystinosis: Statement from an international conference. J Inherit Metab Dis 2019; 42:1019-1029. [PMID: 31177550 PMCID: PMC7379238 DOI: 10.1002/jimd.12134] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
Cystinosis is an autosomal recessive storage disease due to impaired transport of cystine out of lysosomes. Since the accumulation of intracellular cystine affects all organs and tissues, the management of cystinosis requires a specialized multidisciplinary team consisting of pediatricians, nephrologists, nutritionists, ophthalmologists, endocrinologists, neurologists' geneticists, and orthopedic surgeons. Treatment with cysteamine can delay or prevent most clinical manifestations of cystinosis, except the renal Fanconi syndrome. Virtually all individuals with classical, nephropathic cystinosis suffer from cystinosis metabolic bone disease (CMBD), related to the renal Fanconi syndrome in infancy and progressive chronic kidney disease (CKD) later in life. Manifestations of CMBD include hypophosphatemic rickets in infancy, and renal osteodystrophy associated with CKD resulting in bone deformities, osteomalacia, osteoporosis, fractures, and short stature. Assessment of CMBD involves monitoring growth, leg deformities, blood levels of phosphate, electrolytes, bicarbonate, calcium, and alkaline phosphatase, periodically obtaining bone radiographs, determining levels of critical hormones and vitamins, such as thyroid hormone, parathyroid hormone, 25(OH) vitamin D, and testosterone in males, and surveillance for nonrenal complications of cystinosis such as myopathy. Treatment includes replacement of urinary losses, cystine depletion with oral cysteamine, vitamin D, hormone replacement, physical therapy, and corrective orthopedic surgery. The recommendations in this article came from an expert meeting on CMBD that took place in Salzburg, Austria, in December 2016.
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Affiliation(s)
| | - Frank Rauch
- Shriners Hospital for Children, McGill UniversityMontrealCanada
| | - Gema Ariceta
- Service of Pediatric NephrologyUniversity Hospital Vall d’ HebronBarcelonaSpain
| | - Atif Awan
- Department of NephrologyChildren's University HospitalDublinIreland
| | - Justine Bacchetta
- Référence Center for Rare Renal DiseasesHôpital Femme‐Mère‐EnfantBronFrance
| | - Carsten Bergmann
- Department of MedicineUniversity Hospital FreiburgFreiburgGermany
| | - Susanne Bechtold
- Division of Pediatric EndocrinologyChildren's Hospital and Polyclinic iSPZ, Dr. v. Haunerschen Kinderspital, University Hospital MunichMunichGermany
| | - Noelle Cassidy
- Department of Orthopaedic SurgeryChildren's University HospitalDublinIreland
| | - Geroges Deschenes
- Department of Pediatric NephrologyHôpital Robert‐Debré and University of Paris DiderotParisFrance
| | - Ewa Elenberg
- Department of PediatricsBaylor College of Medicine and Texas Children's HospitalHoustonTexas
| | - William A. Gahl
- National Human Genome Research InstituteNational Institutes of Health Undiagnosed Diseases ProgramBethesdaMaryland
| | - Oliver Greil
- Department of Diagnostic and Interventional RadiologyKlinikum TraunsteinTraunsteinGermany
| | - Erik Harms
- Children‘s University Hospital MuensterMuensterGermany
| | - Nadine Herzig
- Schoen Clinic Munich HarlachingSpecialist Centre for Paediatric and Neuro‐OrthopaedicsMunichGermany
| | - Bernd Hoppe
- Division of Pediatric NephrologyUniversity Children's HospitalBonnGermany
| | - Christian Koeppl
- Kliniken Südostbayern AG, Sozialpädiatrisches ZentrumTraunsteinGermany
| | - Malcolm A. Lewis
- Department of NephrologyChildren's University HospitalDublinIreland
| | - Elena Levtchenko
- Department of Pediatrics & Development and RegenerationUniversity Hospitals Leuven & Katholieke Universiteit LeuvenLeuvenBelgium
| | - Galina Nesterova
- National Institutes of Health, National Human Genome Research Institute (NHGRI)BethesdaMaryland
| | - Fernando Santos
- Hospital Universitario Central de AsturiasPediatríaOviedoSpain
| | - Karl P. Schlingmann
- Department of General PediatricsUniversity Children's Hospital MünsterMünsterGermany
| | - Aude Servais
- Reference Center of Inherited Metabolic Diseases, Nephrology Unit, Hospital Necker Enfants Malades, APHPUniversity Paris DescartesParisFrance
| | - Neveen A. Soliman
- Department of Pediatrics, Center of Pediatric Nephrology and Transplantation (CPNT), Kasr Al Ainy Faculty of MedicineCairo UniversityCairoEgypt
| | - Guenther Steidle
- Kliniken Südostbayern AG, Sozialpädiatrisches ZentrumTraunsteinGermany
| | - Clodagh Sweeney
- Department of NephrologyChildren's University HospitalDublinIreland
| | - Ulrike Treikauskas
- Department of Pediatrics, Department of Pediatric NephrologyRo‐Med KlinikenRosenheimGermany
| | - Rezan Topaloglu
- Department of Pediatric NephrologyHacettepe University Faculty of MedicineAnkaraTurkey
| | - Alexey Tsygin
- Department of NephrologyNational Medical and Research Center for Children's HealthMoscowRussia
| | - Koenraad Veys
- Department of Pediatrics & Development and RegenerationUniversity Hospitals Leuven & Katholieke Universiteit LeuvenLeuvenBelgium
| | - Rodo v. Vigier
- Pediatric ClinicWildermeth Children's HospitalBiel‐BienneSwitzerland
| | - Jozef Zustin
- Institute of Osteology and BiomechanicsUniversity Medical Center Hamburg‐Eppendorf, University of HamburgHamburgGermany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic DiseasesHannover Medical SchoolHannoverGermany
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8
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Matejas V, Hinkes B, Alkandari F, Al-Gazali L, Annexstad E, Aytac MB, Barrow M, Bláhová K, Bockenhauer D, Cheong HI, Maruniak-Chudek I, Cochat P, Dötsch J, Gajjar P, Hennekam RC, Janssen F, Kagan M, Kariminejad A, Kemper MJ, Koenig J, Kogan J, Kroes HY, Kuwertz-Bröking E, Lewanda AF, Medeira A, Muscheites J, Niaudet P, Pierson M, Saggar A, Seaver L, Suri M, Tsygin A, Wühl E, Zurowska A, Uebe S, Hildebrandt F, Antignac C, Zenker M. Mutations in the human laminin beta2 (LAMB2) gene and the associated phenotypic spectrum. Hum Mutat 2010; 31:992-1002. [PMID: 20556798 PMCID: PMC2978072 DOI: 10.1002/humu.21304] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mutations of LAMB2 typically cause autosomal recessive Pierson syndrome, a disorder characterized by congenital nephrotic syndrome, ocular and neurologic abnormalities, but may occasionally be associated with milder or oligosymptomatic disease variants. LAMB2 encodes the basement membrane protein laminin beta2, which is incorporated in specific heterotrimeric laminin isoforms and has an expression pattern corresponding to the pattern of organ manifestations in Pierson syndrome. Herein we review all previously reported and several novel LAMB2 mutations in relation to the associated phenotype in patients from 39 unrelated families. The majority of disease-causing LAMB2 mutations are truncating, consistent with the hypothesis that loss of laminin beta2 function is the molecular basis of Pierson syndrome. Although truncating mutations are distributed across the entire gene, missense mutations are clearly clustered in the N-terminal LN domain, which is important for intermolecular interactions. There is an association of missense mutations and small in frame deletions with a higher mean age at onset of renal disease and with absence of neurologic abnormalities, thus suggesting that at least some of these may represent hypomorphic alleles. Nevertheless, genotype alone does not appear to explain the full range of clinical variability, and therefore hitherto unidentified modifiers are likely to exist.
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Affiliation(s)
- Verena Matejas
- Institute of Human Genetics, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
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9
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Tikhomirov E, Voznesenskaya T, Tsygin A. Novel human pathological mutations. Gene symbol: NPHS1. Disease: congenital nephrotic syndrome, Finnish type. Hum Genet 2009; 125:334. [PMID: 19309778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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10
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Tikhomirov E, Averyanova N, Voznesenskaya T, Tsygin A. Gene symbol: NPHS1. Disease: Congenital nephrotic syndrome, Finnish type. Hum Genet 2008; 124:304. [PMID: 18846635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Eugeny Tikhomirov
- Scientific Centre of Children Health, Genetic Group, Lomonosovsky Prospect, 2/62, 119991 Moscow, Russian Federation.
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11
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Tikhomirov E, Averyanova N, Bayazutdinova G, Voznesenskaya T, Tsygin A. Novel human pathological mutations. Gene symbol: NPHS2. Disease: steroid-resistant nephrotic syndrome. Hum Genet 2007; 122:549. [PMID: 18380020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Eugeny Tikhomirov
- Scientific Centre of Children Health, Genetic Group, Lomonosovsky Prospect, 2/62, 119991, Moscow, RussianFederation.
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