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Stabouli S, Sommer A, Kraft S, Schweer K, Bethe D, Bertholet-Thomas A, Batte S, Ariceta G, Brengmann S, Bacchetta J, Emma F, Levtchenko E, Topaloglu R, Willem L, Haffner D, Oh J. Addressing the psychosocial aspects of transition to adult care in patients with cystinosis. Pediatr Nephrol 2024; 39:2861-2874. [PMID: 38517536 DOI: 10.1007/s00467-024-06345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
Cystinosis is a rare autosomal-recessive lysosomal storage disease that progressively affects multiple organs beginning with the kidneys. Patients require lifelong multidisciplinary care for the management of kidney disease and progressive extra-renal manifestations, and thus, they are especially fragile and vulnerable during transition from pediatric to adult care. Previous documents have provided guidance to help the medical transition of these highly burdened patients. Patients and their families often experience great psychological distress and face significant social challenges; for these reasons, they often need help from psychologists, social workers, and other psychosocial professionals. Due to the rarity of the disease, most psychosocial professionals have no expertise in this disorder and require advice. To this end, a steering committee (SC) composed of six experts, including pediatric nephrologists, psychologists, and social workers with experience in the care for patients with cystinosis, have identified and addressed seven key questions related to psychosocial challenges of the disease and the burden of treatment. Ten additional international experts (the extended faculty, EF) were invited to answer these questions. Since robust evidence is lacking, as in many rare diseases, conclusions were based on collective agreement between members of the SC and the EF, and the consolidated answers were summarized into expert opinion statements. The present document contains information on the concerns and psychosocial burden of patients with cystinosis and of their caregivers, and provides practical advice for timely and appropriate support to facilitate the transition to adult care.
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Affiliation(s)
- Stella Stabouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
| | - Anna Sommer
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Kraft
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Schweer
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Bethe
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Aurelia Bertholet-Thomas
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hospices Civils de Lyon & INSERM1033 Research Unit, Hospital Femme Mere Enfant, Lyon 1 University, Lyon, France
| | - Suzanne Batte
- Children's Renal & Urology Unit, Queens Medical Centre, Nottingham, UK
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Vall d´Hebron, University Autonomous of Barcelona, Barcelona, Spain
| | - Sandra Brengmann
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Justine Bacchetta
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hospices Civils de Lyon & INSERM1033 Research Unit, Hospital Femme Mere Enfant, Lyon 1 University, Lyon, France
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Elena Levtchenko
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Lore Willem
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
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Topaloglu R. Extrarenal complications of cystinosis. Pediatr Nephrol 2024; 39:2283-2292. [PMID: 38127152 DOI: 10.1007/s00467-023-06225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
Cystinosis is a rare autosomal recessive disease with an incidence 1 per 100,000-200,000 live births. It is caused by pathogenic variants of the cystinosin (CTNS) gene that lead to impaired cystine transport from lysosomes to cystosol, resulting in cystine accumulation in lysosomes and subsequent cellular dysfunction. The initial manifestation, cystine accumulation in proximal tubular cells (PTCs), causes renal Fanconi syndrome, which presents with proximal renal tubular acidosis and generalized dysfunction of the proximal tubule, including the presence of polyuria, glycosuria, phosphaturia, aminoaciduria, tubular proteinuria, growth retardation, and rickets. Eventually, glomerular involvement, glomerular proteinuria, focal segmental glomerulosclerosis (FSGS), and progression to kidney failure occur. Although the kidneys are the first organs affected, and play a key role in morbidity and mortality, extrarenal multiorgan involvement can occur in patients with cystinosis, which is seen not only in adults but in early ages in untreated patients, patients with insufficient treatment, and in those that don't comply with treatment. The treatment of cystinosis consists of supportive treatment for Fanconi syndrome, and specific lifelong cystine-depleting therapy using oral cysteamine. There is strong evidence that as early as possible, initiation and ongoing appropriate therapy with cysteamine are essential for delaying the progression to kidney failure, end-organ damage, and extrarenal involvement. The present review aimed to evaluate the extra renal complications of cystinosis.
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Affiliation(s)
- Rezan Topaloglu
- Hacettepe University, School of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye.
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