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Al-Shebel A, Michel G, Breiderhoff T, Müller D. Urinary Acidification Does Not Explain the Absence of Nephrocalcinosis in a Mouse Model of Familial Hypomagnesaemia with Hypercalciuria and Nephrocalcinosis (FHHNC). Int J Mol Sci 2024; 25:1779. [PMID: 38339056 PMCID: PMC10855382 DOI: 10.3390/ijms25031779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Patients with mutations in Cldn16 suffer from familial hypomagnesaemia with hypercalciuria and nephrocalcinosis (FHHNC) which can lead to renal insufficiency. Mice lacking claudin-16 show hypomagnesemia and hypercalciuria, but no nephrocalcinosis. Calcium oxalate and calcium phosphate are the most common insoluble calcium salts that accumulate in the kidney in the case of nephrocalcinosis, however, the formation of these salts is less favored in acidic conditions. Therefore, urine acidification has been suggested to limit the formation of calcium deposits in the kidney. Assuming that urine acidification is causative for the absence of nephrocalcinosis in the claudin-16-deficient mouse model, we aimed to alkalinize the urine of these mice by the ablation of the subunit B1 of the vesicular ATPase in addition to claudin-16. In spite of an increased urinary pH in mice lacking claudin-16 and the B1 subunit, nephrocalcinosis did not develop. Thus, urinary acidification is not the only factor preventing nephrocalcinosis in claudin-16 deficient mice.
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Affiliation(s)
- Amr Al-Shebel
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Augustenburger Platz 1, 13353 Berlin, Germany; (T.B.); (D.M.)
| | - Geert Michel
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Research Institutes for Experimental Medicine, Transgenic Technologies, Robert Rössle Str. 10, 13125 Berlin, Germany;
| | - Tilman Breiderhoff
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Augustenburger Platz 1, 13353 Berlin, Germany; (T.B.); (D.M.)
| | - Dominik Müller
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Augustenburger Platz 1, 13353 Berlin, Germany; (T.B.); (D.M.)
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2
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Ding F, Zhang L, Wu X, Liu Y, Wan Y, Hu J, Zhang X, Wu Q. Melatonin ameliorates renal dysfunction in glyphosate- and hard water-treated mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 241:113803. [PMID: 36068739 DOI: 10.1016/j.ecoenv.2022.113803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/05/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Chronic interstitial nephritis in agricultural communities (CINAC) is a severe and widespread disease that has been associated with environmental and occupational exposure to glyphosate and hard water. However, the potential underlying mechanisms remain incompletely understood. Melatonin is reported to exert protective effects on the kidney, but whether melatonin can attenuate renal tubular injury in mice exposed to glyphosate combined with hard water is unclear. Here, mice were treated with high doses and environmentally relevant doses of glyphosate (100 mg/kg·bw and 0.7 mg/L, respectively) and/or hard water (2500 mg/L CaCO3 and 250 mg/L Ca2+, respectively) via their drinking water for 12 weeks. We found that high-dose glyphosate or hard water treatment significantly increased the levels of biomarkers of renal damage, including β2-microglobulin, neutrophil gelatinase-associated lipid carrier protein, and/or albumin, in the urine; these increased biomarker levels were correlated with obvious morphological changes, and all of these changes were also observed in animals exposed to environmentally relevant doses of glyphosate and/or high Ca2+ water. Melatonin (10 mg/kg·bw, intraperitoneal injection, daily for 12 weeks) administered concomitantly with high doses of glyphosate and hard water inhibited the glyphosate- and hard water-induced increases in the levels of kidney injury biomarkers and changes in morphology; this result was intriguing. Additionally, glyphosate combined with hard water at both high and environmentally relevant doses significantly upregulated the expression of the endoplasmic reticulum (ER) stress marker proteins Bip, ATF6, and PERK as well as the pyroptosis-related proteins (NLRP3 and caspase 1 signaling proteins) in renal tissues. Similarly, melatonin significantly attenuated the increased ER stress and pyroptosis induced by high doses of glyphosate and hard water. In summary, we conclude that exposure to glyphosate and hard water at both high doses and environmentally relevant doses causes renal dysfunction in mice, and this dysfunction can be attenuated by melatonin, possibly through the inhibition of ER stress and pyroptosis. Our results support the notion that melatonin may have therapeutic potential for the treatment of chronic kidney diseases.
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Affiliation(s)
- Fan Ding
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Lin Zhang
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China; Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Wu
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Yingying Liu
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Yi Wan
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Jianying Hu
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Xiaoyan Zhang
- Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, China.
| | - Qing Wu
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China.
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3
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Zhang L, Ding F, Wang R, Wu X, Wan Y, Hu J, Wu Q. Involvement of mitochondrial fission in renal tubular pyroptosis in mice exposed to high and environmental levels of glyphosate combined with hard water. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 283:117082. [PMID: 33848899 DOI: 10.1016/j.envpol.2021.117082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/20/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
Chronic interstitial nephritis in agricultural communities (CINAC) has reached epidemic proportions. The combination of glyphosate and hard water has been postulated to play a potent aetiological role in CINAC. Therefore, dynamin-related protein 1 (Drp1)-mediated aberrant mitochondrial fission and subsequent activation of the nucleotide-binding oligomerization domain (NOD)-like receptor protein 3 (Nlrp3)/caspase1 pathway may be involved in the pathogenesis of nephropathy. In the present study, mice were sub-chronically exposed to high doses and environmental levels of glyphosate (100 mg/kg body weight (mg/kg·bw) glyphosate in Roundup and 0.7 mg/L pure glyphosate, respectively) and hard water (2500 mg/L CaCO3 and 250 mg/L Ca2+, respectively) in drinking water. Moreover, Mdivi-1 (Md-1, 10 mg/kg·bw) was intraperitoneally injected to inhibit Drp1 on the basis of the high-dose experiment. Histopathological examination, biochemical analysis, ELISA, western blotting and fluorescent staining were used to analyse renal structure, renal tubular pyroptosis and mitochondrial fission/fusion alterations. The results showed dramatic proximal tubular injury, particularly in the combined groups. Moreover, significant increases in the protein expression levels of calmodulin (CaM), calmodulin-dependent protein kinase II (CaMKII), Drp1/p-Drp1-Ser616 and the Txnip/Nlrp3/caspase1 signalling pathway, and alterations in oxidative stress were observed in the combined groups, and these effects were attenuated by the Drp1 inhibitor Md-1. Intriguingly, there may be a synergistic effect of glyphosate and hard water on renal injury. Taken together, these results suggest that the combination of glyphosate and hard water, even at environmental exposure levels, enhances pyroptosis and ongoing tubulointerstitial inflammation through excessive Drp1-mediated mitochondrial fission.
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Affiliation(s)
- Lin Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Fan Ding
- School of Public Health, Fudan University, Shanghai, China
| | - Ruojing Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Xuan Wu
- School of Public Health, Fudan University, Shanghai, China
| | - Yi Wan
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Jianying Hu
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Qing Wu
- School of Public Health, Fudan University, Shanghai, China.
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4
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Chidambaram AC, Krishnamurthy S, Darshith SL, Karunakar P, Deepthi B, Gunasekaran D, Ramamoorthy JG. A 5-year-old boy with refractory rickets, polyuria, and hypokalemic metabolic alkalosis: Answers. Pediatr Nephrol 2021; 36:297-302. [PMID: 32519157 DOI: 10.1007/s00467-020-04616-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Aakash Chandran Chidambaram
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | | | - Pediredla Karunakar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Bobbity Deepthi
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Dhandapany Gunasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
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Ye Q, Shen Q, Rao J, Zhang A, Zheng B, Liu X, Shen Y, Chen Z, Wu Y, Hou L, Jian S, Wei M, Ma M, Sun S, Li Q, Dang X, Wang Y, Xu H, Mao J. Multicenter study of the clinical features and mutation gene spectrum of Chinese children with Dent disease. Clin Genet 2020; 97:407-417. [PMID: 31674016 DOI: 10.1111/cge.13663] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/07/2019] [Accepted: 10/12/2019] [Indexed: 01/21/2023]
Abstract
Dent disease is a rare X-linked recessive inherited tubular disease. In this multicenter study, the clinical presentation and genetic background of Chinese children with Dent disease are studied to improve the cognition and diagnostic ability of pediatricians. In this prospective cohort, we described the genotype and phenotype of a national cohort composed of 45 pediatric probands with Dent disease belonging to 45 families from 12 different regions of China recruited from 2014 to 2018 by building up the multicenter registration system. The CLCN5 gene from 32 affected families revealed 28 different mutations. The OCRL gene from 13 affected families revealed 13 different mutations. The incidence of low-molecular-weight proteinuria (LMWP) in both Dent disease type 1 populations and Dent disease type 2 populations was 100.0%; however, the incidence of other manifestations was not high, which was similar to previously reported data. Therefore, LMWP is a key clinical feature that should alert clinicians to the possibility of Dent disease. A high amount of LMWP combined with positive gene test results can be used as the diagnostic criteria for this disease. The diagnostic criteria are helpful in reducing the missed diagnosis of this disease and are beneficial for protecting the renal function of these patients through early diagnosis and early intervention.
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Affiliation(s)
- Qing Ye
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National clinical research center for child health, Hangzhou, China
| | - Qian Shen
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.,Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China.,Shanghai Key Lab of Birth Defect, Children's Hospital of Fudan University, Shanghai, China
| | - Jia Rao
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.,Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China.,Shanghai Key Lab of Birth Defect, Children's Hospital of Fudan University, Shanghai, China
| | - Aihua Zhang
- Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Bixia Zheng
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University Nanjing, China
| | - Xiaorong Liu
- Department of Nephrology, Bejing Children's Hospital Affiliated to Capital University of Medical Science, Beijing, China.,Beijing Children's Key Laboratory of Chronic Kidney Disease and Blood Purification, Beijing, China
| | - Ying Shen
- Department of Nephrology, Bejing Children's Hospital Affiliated to Capital University of Medical Science, Beijing, China.,Beijing Children's Key Laboratory of Chronic Kidney Disease and Blood Purification, Beijing, China
| | - Zhi Chen
- Department of Nephrology, Bejing Children's Hospital Affiliated to Capital University of Medical Science, Beijing, China.,Beijing Children's Key Laboratory of Chronic Kidney Disease and Blood Purification, Beijing, China
| | - Yubing Wu
- Department of Pediatric Nephrology and Rheumatology, Shengfing Hospital of China Medical University, Shenyang, China
| | - Ling Hou
- Department of Pediatric Nephrology and Rheumatology, Shengfing Hospital of China Medical University, Shenyang, China
| | - Shan Jian
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Min Wei
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Ma
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Shuzhen Sun
- Department of Pediatric, Nephrology, Rheumatism and Immunology, Shandong Provincial Hospital, Jinan, China
| | - Qian Li
- Department of Pediatric, Nephrology, Rheumatism and Immunology, Shandong Provincial Hospital, Jinan, China
| | - Xiqiang Dang
- Department of Pediatric, Xiangya Hospital Central South University, Changsha, China
| | - Ying Wang
- Department of Pediatric, Xiangya Hospital Central South University, Changsha, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.,Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China.,Shanghai Key Lab of Birth Defect, Children's Hospital of Fudan University, Shanghai, China
| | - Jianhua Mao
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National clinical research center for child health, Hangzhou, China
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6
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Bitsori M, Vergadi E, Galanakis E. A Novel CLCN5 Splice Site Mutation in a Boy with Incomplete Phenotype of Dent Disease. J Pediatr Genet 2019; 8:235-239. [PMID: 31687264 DOI: 10.1055/s-0039-1692172] [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: 02/17/2019] [Accepted: 04/22/2019] [Indexed: 12/15/2022]
Abstract
Dent disease is a rare X-linked renal proximal tubulopathy presenting with low-molecular-weight proteinuria (LMWP), hypercalciuria, and nephrocalcinosis, other signs of incomplete renal Fanconi syndrome, and renal failure. Early identification of patients who harbor disease-associated mutations is important for effective medical care and avoidance of unnecessary interventions. We report the case of an asymptomatic 9-year-old boy who presented with proteinuria in routine examination. Further investigation revealed the presence of nephrotic range proteinuria, mostly LMWP and mild hypercalciuria without nephrocalcinosis, or other features of tubular dysfunction. Renal function, growth, and bone mineral density were within regular limits. The male gender and the presence of LMWP and hypercalciuria even in the absence of other findings prompted us to genetic investigation for Dent disease. A novel splice site mutation (c.416-2A > G) of the chloride voltage-gated channel 5 ( CLCN5 ) gene, responsible for Dent disease type 1 was identified. In silico analysis revealed that this mutation interferes with the mating of exons 4 and 5. Due to early molecular diagnosis, our patient did not undergo a renal biopsy, neither required aggressive pharmacological interventions. This case underscores the diversity and complexity of CLCN5 mutations and highlights the importance of early molecular testing in male patients with incomplete phenotype of Dent disease.
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Affiliation(s)
- Maria Bitsori
- Department of Paediatrics, Heraklion University Hospital, Crete, Greece
| | - Eleni Vergadi
- Department of Paediatrics, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, School of Medicine, University of Crete, Heraklion, Crete, Greece
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7
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Abstract
Dent disease is an X-linked form of chronic kidney disease characterized by hypercalciuria, low molecular weight proteinuria, nephrocalcinosis, and proximal tubular dysfunction. Clinical presentation is highly variable. Male patients may present with early-onset rickets, recurrent nephrolithiasis, or insidiously with asymptomatic proteinuria or chronic kidney disease. Mutations in both the CLCN5 and OCRL1 genes have been associated with the Dent phenotype and are now classified as Dent-1 and Dent-2, respectively. This article describes the clinical presentation, laboratory evaluation, genetics, pathophysiology, management, and future therapies of Dent disease.
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Affiliation(s)
- Abdulla M Ehlayel
- Division of Nephrology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Lawrence Copelovitch
- Division of Nephrology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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8
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Oliveira B, Unwin R, Walsh SB. Inherited proximal tubular disorders and nephrolithiasis. Urolithiasis 2019; 47:35-42. [PMID: 30673801 DOI: 10.1007/s00240-018-01103-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/08/2018] [Indexed: 12/20/2022]
Abstract
The proximal tubule is responsible for reclaiming water, phosphates and amino acids from the tubular filtrate. There are genetic defects in both phosphate and amino acid transporters leading to nephrolithiasis. This review also explores genetic defects in regulators of phosphate and calcium transport in this nephron segment that lead to stone formation.
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Affiliation(s)
- Ben Oliveira
- Royal Free Hospital/Medical School, Centre for Nephrology, University College London, London, NW3 2PF, UK
| | - Robert Unwin
- Royal Free Hospital/Medical School, Centre for Nephrology, University College London, London, NW3 2PF, UK.,AstraZeneca IMED ECD CVRM R&D, Gothenburg, Sweden
| | - Stephen B Walsh
- Royal Free Hospital/Medical School, Centre for Nephrology, University College London, London, NW3 2PF, UK.
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9
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Zaniew M, Mizerska-Wasiak M, Załuska-Leśniewska I, Adamczyk P, Kiliś-Pstrusińska K, Haliński A, Zawadzki J, Lipska-Ziętkiewicz BS, Pawlaczyk K, Sikora P, Ludwig M, Szczepańska M. Dent disease in Poland: what we have learned so far? Int Urol Nephrol 2017; 49:2005-2017. [PMID: 28815356 DOI: 10.1007/s11255-017-1676-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Dent disease (DD) is a rare tubulopathy characterized by proximal tubular dysfunction leading to chronic kidney disease (CKD). The aim of the study was to characterize patients with DD in Poland. METHODS A retrospective analysis of a national cohort with genetically confirmed diagnosis. RESULTS Of 24 males, all patients except one carried mutations in the CLCN5 gene; in one patient a mutation in the OCRL gene was disclosed. Molecular diagnosis was delayed 1 year on average (range 0-21 years). The most common features were tubular proteinuria (100%), hypercalciuria (87%), and nephrocalcinosis (56%). CKD (≤stage II) and growth deficiency were found in 45 and 22% of patients, respectively. Over time, a progression of CKD and persistence of growth impairment was noted. Subnephrotic and nephrotic proteinuria (20%) was found in most patients, but tubular proteinuria was assessed in only 67% of patients. In one family steroid-resistant nephrotic syndrome prompted a genetic testing, and reverse phenotyping. Five children (20%) underwent kidney biopsy, and two of them were treated with immunosuppressants. Hydrochlorothiazide and angiotensin-converting enzyme inhibitors were prescribed for a significant proportion of patients (42 and 37.5%, respectively), while supplemental therapy with phosphate, potassium, vitamin D (12.5% each), and alkali (4.2%) was insufficient, when compared to the percentages of patients requiring repletion. CONCLUSIONS We found CLCN5 mutations in the vast majority of Polish patients with DD. Proteinuria was the most constant finding; however, tubular proteins were not assessed commonly, likely leading to delayed molecular diagnosis and misdiagnosis in some patients. More consideration should be given to optimize the therapy.
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Affiliation(s)
- Marcin Zaniew
- Children's Hospital, ul. Krysiewicza 7/8, 61-825, Poznan, Poland. .,Polish Registry of Inherited Tubulopathies (POLtube), Polish Society of Pediatric Nephrology, Poznan, Poland.
| | | | - Iga Załuska-Leśniewska
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Adamczyk
- Department and Clinics of Pediatrics, SMDZ, Medical University of Silesia in Katowice, Zabrze, Poland
| | | | - Adam Haliński
- Department of Urology, Regional Hospital, Nowa Sól, Poland
| | - Jan Zawadzki
- Department of Nephrology and Kidney Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Beata S Lipska-Ziętkiewicz
- Department of Biology and Medical Genetics, Clinical Genetics Unit, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemysław Sikora
- Polish Registry of Inherited Tubulopathies (POLtube), Polish Society of Pediatric Nephrology, Poznan, Poland.,Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Maria Szczepańska
- Department and Clinics of Pediatrics, SMDZ, Medical University of Silesia in Katowice, Zabrze, Poland
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Zhang H, Wang F, Xiao H, Yao Y. Dent disease: Same CLCN5 mutation but different phenotypes in two brothers in China. Intractable Rare Dis Res 2017; 6:114-118. [PMID: 28580211 PMCID: PMC5451742 DOI: 10.5582/irdr.2017.01019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Dent disease is an X-linked recessive proximal tubular disorder that affects mostly male patients in childhood or early adult life, caused by mutations in CLCN5 (Dent disease 1) or OCRL (Dent disease 2) genes, respectively. It presents mainly with hypercalciuria, low-molecular-weight proteinuria, nephrocalcinosis and progressive renal failure. We report here the same CLCN5 mutation but different phenotypes in two Chinese brothers, and speculate on the possible reasons for the variability of the genotype-phenotype correlations.
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Affiliation(s)
- Hongwen Zhang
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Fang Wang
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Huijie Xiao
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Yong Yao
- Department of Pediatric, Peking University First Hospital, Beijing, China
- Address correspondence to: Dr. Yong Yao, Department of Pediatric, Peking University First Hospital, No.1 Xi An Men Da Jie, Beijing 100034, China. E-mail:
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11
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Oliveira B, Kleta R, Bockenhauer D, Walsh SB. Genetic, pathophysiological, and clinical aspects of nephrocalcinosis. Am J Physiol Renal Physiol 2016; 311:F1243-F1252. [DOI: 10.1152/ajprenal.00211.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022] Open
Abstract
Nephrocalcinosis describes the ectopic deposition of calcium salts in the kidney parenchyma. Nephrocalcinosis can result from a number of acquired causes but also an even greater number of genetic diseases, predominantly renal but also extrarenal. Here we provide a review of the genetic causes of nephrocalcinosis, along with putative mechanisms, illustrated by human and animal data.
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Affiliation(s)
- Ben Oliveira
- University College London, Centre for Nephrology, London, United Kingdom
| | - Robert Kleta
- University College London, Centre for Nephrology, London, United Kingdom
| | - Detlef Bockenhauer
- University College London, Centre for Nephrology, London, United Kingdom
| | - Stephen B. Walsh
- University College London, Centre for Nephrology, London, United Kingdom
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12
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Observations of a large Dent disease cohort. Kidney Int 2016; 90:430-439. [DOI: 10.1016/j.kint.2016.04.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 04/21/2016] [Accepted: 04/28/2016] [Indexed: 01/30/2023]
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13
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Li F, Yue Z, Xu T, Chen M, Zhong L, Liu T, Jing X, Deng J, Hu B, Liu Y, Wang H, Lai KN, Sun L, Liu J, Maxwell PH, Wang Y. Dent Disease in Chinese Children and Findings from Heterozygous Mothers: Phenotypic Heterogeneity, Fetal Growth, and 10 Novel Mutations. J Pediatr 2016; 174:204-210.e1. [PMID: 27174143 PMCID: PMC7611024 DOI: 10.1016/j.jpeds.2016.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/21/2016] [Accepted: 04/05/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To characterize the phenotypes of Dent disease in Chinese children and their heterozygous mothers and to establish genetic diagnoses. STUDY DESIGN Using a modified protocol, we screened 1288 individuals with proteinuria. A diagnosis of Dent disease was established in 19 boys from 16 families by the presence of loss of function/deleterious mutations in CLCN5 or OCRL1. We also analyzed 16 available patients' mothers and examined their pregnancy records. RESULTS We detected 14 loss of function/deleterious mutations of CLCN5 in 15 boys and 2 mutations of OCRL1 in 4 boys. Of the patients, 16 of 19 had been wrongly diagnosed with other diseases and 11 of 19 had incorrect or unnecessary treatment. None of the patients, but 6 of 14 mothers, had nephrocalcinosis or nephrolithiasis at diagnosis. Of the patients, 8 of 14 with Dent disease 1 were large for gestational age (>90th percentile); 8 of 15 (53.3%) had rickets. We also present predicted structural changes for 4 mutant proteins. CONCLUSIONS Pediatric Dent disease often is misdiagnosed; genetic testing achieves a correct diagnosis. Nephrocalcinosis or nephrolithiasis may not be sensitive diagnostic criteria. We identified 10 novel mutations in CLCN5 and OCRL1. The possibility that altered CLCN5 function could affect fetal growth and a possible link between a high rate of rickets and low calcium intake are discussed.
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Affiliation(s)
- Fucheng Li
- Department of Medical Genetics, Genome Research Center, Zhongshan School of Medicine, Sun Yat-sen University
| | - Zhihui Yue
- Children’s Kidney Disease Center, Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University
| | - Tingting Xu
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences
| | - Minghui Chen
- Center for Reproductive Medicine, Sun Yat-sen University
| | - Liangying Zhong
- Department of Clinical Laboratory, First Affiliated Hospital, Sun Yat-sen University
| | - Ting Liu
- Children’s Kidney Disease Center, Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University
| | - Xiangyi Jing
- Prenatal Diagnosis Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong Province, China
| | - Jia Deng
- Reproductive Center, Changsha Hospital for Maternal & Children Health Care, Changsha, Hunan Province, China
| | - Bin Hu
- Department of Medical Genetics, Genome Research Center, Zhongshan School of Medicine, Sun Yat-sen University
| | - Yuling Liu
- Department of Pediatrics, Boai Hospital, Zhongshan
| | - Haiyan Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Kar N. Lai
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Liangzhong Sun
- Children’s Kidney Disease Center, Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University
| | - Jinsong Liu
- State Key Laboratory of Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences
| | - Patrick H. Maxwell
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Yiming Wang
- Xinhua College, Sun Yat-sen University, Guangzhou, Guangdong Province, China; Beijing Genomics Institute (BGI) in Shenzhen, Guangdong Province, China.
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14
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Abstract
The oculocerebrorenal syndrome of Lowe is a rare X-linked multisystemic disorder characterized by the triad of congenital cataracts, intellectual disability, and proximal renal tubular dysfunction. Whereas the ocular manifestations and severe muscular hypotonia are the typical first diagnostic clues apparent at birth, the manifestations of incomplete renal Fanconi syndrome are often recognized only later in life. Other characteristic features are progressive severe growth retardation and behavioral problems, with tantrums. Many patients develop a debilitating arthropathy. Treatment is symptomatic, and the life span rarely exceeds 40 years. The causative oculocerebrorenal syndrome of Lowe gene (OCRL) encodes the inositol polyphosphate 5-phosphatase OCRL-1. OCRL variants have not only been found in classic Lowe syndrome, but also in patients with a predominantly renal phenotype classified as Dent disease type 2 (Dent-2). Recent data indicate that there is a phenotypic continuum between Dent-2 disease and Lowe syndrome, suggesting that there are individual differences in the ability to compensate for the loss of enzyme function. Extensive research has demonstrated that OCRL-1 is involved in multiple intracellular processes involving endocytic trafficking and actin skeleton dynamics. This explains the multi-organ manifestations of the disease. Still, the mechanisms underlying the wide phenotypic spectrum are poorly understood, and we are far from a causative therapy. In this review, we provide an update on clinical and molecular genetic findings in Lowe syndrome and the cellular and physiological functions of OCRL-1.
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15
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De Mutiis C, Pasini A, La Scola C, Pugliese F, Montini G. Nephrotic-range Albuminuria as the presenting symptom of Dent-2 disease. Ital J Pediatr 2015; 41:46. [PMID: 26108450 PMCID: PMC4479313 DOI: 10.1186/s13052-015-0152-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/16/2015] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Dent disease is a rare X-linked tubulopathy with low molecular weight proteinuria, hypercalciuria, nephrolithiasis, nephrocalcinosis and progressive renal failure. We describe the case of a 9-year-old boy who presented with nephrotic-range albuminuria at the age of 3 years. In the absence of a clear diagnosis, a renal biopsy was performed at 4 years, which revealed minimal change disease. Due to the presence of low molecular weight proteinuria, even in the absence of hypercalciuria, a diagnosis of Dent disease was considered. While there were no mutations in the CLCN5 gene, the diagnosis was confirmed by the presence of a missense mutation (p.Arg318Cys) in the OCRL gene. CONCLUSION Given the large phenotypic variability of the disease and based on our experience, we believe that children with low molecular weight proteinuria, even without hypercalciuria, should be investigated for Dent disease.
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Affiliation(s)
- Chiara De Mutiis
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Fabrizio Pugliese
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Giovanni Montini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy.
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16
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Mansour-Hendili L, Blanchard A, Le Pottier N, Roncelin I, Lourdel S, Treard C, González W, Vergara-Jaque A, Morin G, Colin E, Holder-Espinasse M, Bacchetta J, Baudouin V, Benoit S, Bérard E, Bourdat-Michel G, Bouchireb K, Burtey S, Cailliez M, Cardon G, Cartery C, Champion G, Chauveau D, Cochat P, Dahan K, De la Faille R, Debray FG, Dehoux L, Deschenes G, Desport E, Devuyst O, Dieguez S, Emma F, Fischbach M, Fouque D, Fourcade J, François H, Gilbert-Dussardier B, Hannedouche T, Houillier P, Izzedine H, Janner M, Karras A, Knebelmann B, Lavocat MP, Lemoine S, Leroy V, Loirat C, Macher MA, Martin-Coignard D, Morin D, Niaudet P, Nivet H, Nobili F, Novo R, Faivre L, Rigothier C, Roussey-Kesler G, Salomon R, Schleich A, Sellier-Leclerc AL, Soulami K, Tiple A, Ulinski T, Vanhille P, Van Regemorter N, Jeunemaître X, Vargas-Poussou R. Mutation Update of the CLCN5 Gene Responsible for Dent Disease 1. Hum Mutat 2015; 36:743-52. [PMID: 25907713 DOI: 10.1002/humu.22804] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/08/2015] [Indexed: 02/06/2023]
Abstract
Dent disease is a rare X-linked tubulopathy characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis and/or nephrolithiasis, progressive renal failure, and variable manifestations of other proximal tubule dysfunctions. It often progresses over a few decades to chronic renal insufficiency, and therefore molecular characterization is important to allow appropriate genetic counseling. Two genetic subtypes have been described to date: Dent disease 1 is caused by mutations of the CLCN5 gene, coding for the chloride/proton exchanger ClC-5; and Dent disease 2 by mutations of the OCRL gene, coding for the inositol polyphosphate 5-phosphatase OCRL-1. Herein, we review previously reported mutations (n = 192) and their associated phenotype in 377 male patients with Dent disease 1 and describe phenotype and novel (n = 42) and recurrent mutations (n = 24) in a large cohort of 117 Dent disease 1 patients belonging to 90 families. The novel missense and in-frame mutations described were mapped onto a three-dimensional homology model of the ClC-5 protein. This analysis suggests that these mutations affect the dimerization process, helix stability, or transport. The phenotype of our cohort patients supports and extends the phenotype that has been reported in smaller studies.
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Affiliation(s)
- Lamisse Mansour-Hendili
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Blanchard
- Faculté de Médecine, Université Paris Descartes, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'investigation clinique, Hôpital Européen Georges Pompidou, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
| | - Nelly Le Pottier
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Roncelin
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Stéphane Lourdel
- Sorbonne Universités, UPMC Université, Paris, France.,INSERM, Université Paris Descartes, Sorbonne Paris Cité, UMR S1138, Centre de Recherche des Cordeliers, CNRS ERL 8228, Paris, F-75006, France
| | - Cyrielle Treard
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France
| | - Wendy González
- Centro de Bioinformática y Simulación Molecular, Universidad de Talca, Talca, Chile
| | - Ariela Vergara-Jaque
- Centro de Bioinformática y Simulación Molecular, Universidad de Talca, Talca, Chile
| | - Gilles Morin
- Service de Génétique et Oncogénétique, Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
| | - Estelle Colin
- Département de Biochimie et Génétique, LUNAM Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Muriel Holder-Espinasse
- Département de Génétique, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Clinical Genetics, Guy's Hospital, London, United Kingdom
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares. Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Véronique Baudouin
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Stéphane Benoit
- Service de Néphrologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Etienne Bérard
- Service de Néphrologie pédiatrique, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Karim Bouchireb
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie Pédiatrique, Paris, France
| | - Stéphane Burtey
- VRCM, centre de néphrologie et transplantation rénale, Aix-Marseille Université, Marseille, France
| | - Mathilde Cailliez
- Assistance Publique Hôpitaux de Marseille, Unité de Néphrologie Pédiatrique, Hôpital La Timone, Marseille, France
| | - Gérard Cardon
- Service de Néphrologie, Centre Hospitalier de Douai, Douai, France
| | - Claire Cartery
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie et dialyse, Hôpital Tenon, Paris, France
| | - Gerard Champion
- Département de Pédiatrie, LUNAM Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Dominique Chauveau
- Centre Hospitalier Universitaire de Toulouse, Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Toulouse, France
| | - Pierre Cochat
- Centre de Référence des Maladies Rénales Rares. Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Karin Dahan
- Département de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Renaud De la Faille
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Laurenne Dehoux
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Georges Deschenes
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Estelle Desport
- Service de Néphrologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Devuyst
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Stella Dieguez
- Nefrologia Infantil, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina
| | - Francesco Emma
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michel Fischbach
- Service de Pédiatrie, Centre Hospitalier Universitaire Hautepierre, Strasbourg, France
| | - Denis Fouque
- Departement de Néphrology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France
| | - Jacques Fourcade
- Service de Néphrology, Centre Hospitalier de Chambery, Chambery, France
| | - Hélène François
- Assistance Publique-Hôpitaux de Paris, Hôpital Kremlin Bicêtre, Service de Néphrologie, Le Kremlin-Bicêtre, France
| | - Brigitte Gilbert-Dussardier
- Centre Hospitalier Universitaire de Poitiers, Service de Génétique, EA 3808, Université de Poitiers, Poitiers, France
| | - Thierry Hannedouche
- Hôpitaux Universitaires de Strasbourg, Service de Néphrologie et Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Pascal Houillier
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,INSERM, Université Paris Descartes, Sorbonne Paris Cité, UMR S1138, Centre de Recherche des Cordeliers, CNRS ERL 8228, Paris, F-75006, France.,Assistance Publique Hôpitaux de Paris, Département de Physiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Hassan Izzedine
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Service de Néphrologie, Paris, France
| | - Marco Janner
- Department of Paediatric Endocrinology, Diabetology and Metabolism, University of Berne Children's Hospital, Berne, Switzerland
| | - Alexandre Karras
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Néphrologie, Paris, France
| | - Bertrand Knebelmann
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie adulte, Paris, France
| | - Marie-Pierre Lavocat
- Département de Pédiatrie, Centre Hospitalier Universitaire de Saint Etienne, Hôpital Nord, Saint Etienne, France
| | - Sandrine Lemoine
- Hospices Civils de Lyon, Service d'Exploration Fonctionnelle Rénale, Hôpital Edouard-Herriot, Lyon, France
| | - Valérie Leroy
- Hôpital Jeanne de Flandre, Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Chantal Loirat
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Marie-Alice Macher
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | | | - Denis Morin
- Unité de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Patrick Niaudet
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie Pédiatrique, Paris, France
| | - Hubert Nivet
- Service de Néphrologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - François Nobili
- Unité de Néphrologie Pédiatrie, Besançon, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Robert Novo
- Hôpital Jeanne de Flandre, Service de Néphrologie Pédiatrique, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurence Faivre
- Centre de Génétique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Claire Rigothier
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Remi Salomon
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-malades, Service de Néphrologie Pédiatrique, Paris, France
| | - Andreas Schleich
- Institute of Nephrology Statspital Waid Zuerich, Zuerich, Switzerland
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares. Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | | | - Aurélien Tiple
- Centre Hospitalier Universitaire Gabriel-Montpied Service de Néphrologie, Clermont-Ferrand, France
| | - Tim Ulinski
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Néphrologie et Transplantation Rénale, Hôpital Trousseau, Paris, France
| | - Philippe Vanhille
- Centre Hospitalier de Valenciennes, Service de Néphrologie et Médecine Interne, Valenciennes, France
| | - Nicole Van Regemorter
- Université Libre de Bruxelles, Hôpital Erasme Département de Génétique Médicale, Brussels, Belgium
| | - Xavier Jeunemaître
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
| | - Rosa Vargas-Poussou
- Assistance Publique-Hôpitaux de Paris, Service de Génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM, UMR970, Paris-Cardiovascular Research Center, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
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17
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Pusch M, Zifarelli G. ClC-5: Physiological role and biophysical mechanisms. Cell Calcium 2014; 58:57-66. [PMID: 25443653 DOI: 10.1016/j.ceca.2014.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/19/2014] [Accepted: 09/20/2014] [Indexed: 01/05/2023]
Abstract
Cl(-) transport in animal cells has fundamental physiological roles and it is mediated by a variety of protein families, one of them being the CLC family of ion channels and transporters. Besides their physiological relevance, CLC proteins show peculiar biophysical properties. This review will focus on a member of the CLC protein family, the endosomal Cl(-)/H(+) antiporter ClC-5. ClC-5 mutations cause Dent's disease, a renal syndrome due to defective protein reabsorption in the proximal tubule. This established the critical function of ClC-5 for endocytosis. However, our understanding of ClC-5's molecular role in endosomes and of its biophysical properties has proved elusive in spite of important progress achieved in the last two decades. Early models in which ClC-5 would provide a shunt conductance to enable efficient endosomal acidification conflicted with the antiport activity of ClC-5 that has more recently emerged. Currently, the physiological role of ClC-5 is hotly debated and its biophysical properties are still not fully understood.
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Affiliation(s)
- Michael Pusch
- Istituto di Biofisica, CNR, Via De Marini 6, 16149 Genoa, Italy
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18
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Ludwig M, Levtchenko E, Bökenkamp A. Clinical utility gene card for: Dent disease (Dent-1 and Dent-2). Eur J Hum Genet 2014; 22:ejhg201433. [PMID: 24619144 DOI: 10.1038/ejhg.2014.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Ludwig
- Institute for Clinical Chemistry and Clinical Pharmacology, Bonn University Medical Center, Bonn, Germany
| | - Elena Levtchenko
- Department of Pediatric Nephrology and Growth and Regeneration, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands
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19
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Zhang H, Wang C, Yue H, Hu WW, Gu JM, He JW, Fu WZ, Liu YJ, Zhang Z, Zhang ZL. Identification of a novel mutation in the CLCN5 gene in a Chinese family with Dent-1 disease. Nephrology (Carlton) 2014; 19:80-3. [PMID: 24428215 DOI: 10.1111/nep.12179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Dent disease comprises a group of X-linked recessive inherited renal tubular disorders, the symptoms of which include low-molecular-weight proteinuria (LMWP), hypercalciuria, nephrocalcinosis, and progressive renal failure. We sought to characterize the clinical manifestations and to identify the mutations associated with this disease in Chinese patients. In total, 155 DNA samples were collected from one affected individual, four of his family members, and 150 healthy donors. All 12 exons and the exon-intron boundaries of the CLCN5 gene were amplified and directly sequenced in this Chinese family. The proband demonstrated osteomalacia, which had resulted in more than 10 fractures, LMWP, and renal failure. A single base 'G' deletion at nucleotide 246 (c. 246delG) was identified in exon 5 of the CLCN5 gene in this patient, resulting in a frame shift mutation (fsX) that changed the Threonine (Thr) residue in position 83 to Proline (Pro). The proband's mother was found to be a carrier of this mutation. The present study suggests that a novel frameshift mutation (c. 246delG) in exon 5 of the CLCN5 gene is responsible for Dent disease in this case. Our findings also expand the known spectrum of CLCN5 mutations.
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Affiliation(s)
- Hao Zhang
- Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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20
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Fervenza FC. A patient with nephrotic-range proteinuria and focal global glomerulosclerosis. Clin J Am Soc Nephrol 2013; 8:1979-87. [PMID: 23886564 DOI: 10.2215/cjn.03400313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A young male is evaluated for nephrotic-range proteinuria, hypercalciuria, and an elevated serum creatinine. A renal biopsy is performed and shows focal global glomerulosclerosis. The absence of nephrotic syndrome suggest that glomerulosclerosis was a secondary process. Further analysis of the proteinuria showed it to be due mainly to low-molecular weight proteins. The case illustrates the crucial role of electron microscopy as well as evaluation of the identity of the proteinuria that accompanies a biopsy finding of focal and global or focal and segmental glomerulosclerosis.
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Affiliation(s)
- Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota
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21
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Chutipongtanate S, Fong-ngern K, Peerapen P, Thongboonkerd V. High Calcium Enhances Calcium Oxalate Crystal Binding Capacity of Renal Tubular Cells via Increased Surface Annexin A1 but Impairs Their Proliferation and Healing. J Proteome Res 2012; 11:3650-63. [DOI: 10.1021/pr3000738] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Somchai Chutipongtanate
- Medical Proteomics Unit, Office
for Research and Development, Faculty of Medicine, Siriraj Hospital,
and Center for Research in Complex Systems Science, Mahidol University, 10700 Bangkok, Thailand
| | - Kedsarin Fong-ngern
- Medical Proteomics Unit, Office
for Research and Development, Faculty of Medicine, Siriraj Hospital,
and Center for Research in Complex Systems Science, Mahidol University, 10700 Bangkok, Thailand
| | - Paleerath Peerapen
- Medical Proteomics Unit, Office
for Research and Development, Faculty of Medicine, Siriraj Hospital,
and Center for Research in Complex Systems Science, Mahidol University, 10700 Bangkok, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Office
for Research and Development, Faculty of Medicine, Siriraj Hospital,
and Center for Research in Complex Systems Science, Mahidol University, 10700 Bangkok, Thailand
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22
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Timmis A, Jones C, Paize F. An unusual DMSA scan: answer. Pediatr Nephrol 2012; 27:225-7. [PMID: 21656025 DOI: 10.1007/s00467-011-1914-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 04/28/2011] [Accepted: 04/29/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Alison Timmis
- Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
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Claverie-Martín F, Ramos-Trujillo E, García-Nieto V. Dent's disease: clinical features and molecular basis. Pediatr Nephrol 2011; 26:693-704. [PMID: 20936522 DOI: 10.1007/s00467-010-1657-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/27/2010] [Accepted: 09/06/2010] [Indexed: 02/08/2023]
Abstract
Dent's disease is an X-linked recessive renal tubulopathy characterized by low-molecular-weight proteinuria (LMWP), hypercalciuria, nephrocalcinosis, nephrolithiasis, and progressive renal failure. LMWP is the most constant feature, while the other clinical manifestations show wide variability. Patients also present variable manifestations of proximal tubule dysfunctions, such as aminoaciduria, glucosuria, hyperphosphaturia, kaliuresis, and uricosuria, consistent with renal Fanconi syndrome. Dent's disease affects mainly male children, and female carriers are generally asymptomatic. In two-thirds of patients, the disease is caused by mutations in the CLCN5 gene, which encodes the electrogenic chloride/proton exchanger ClC-5. A few patients have mutations in OCRL1, the gene associated with the oculocerebrorenal syndrome of Lowe, which encodes a phosphatidylinositol-4,5-biphosphate-5-phosphatase (OCRL1). Both ClC-5 and OCRL1 are involved in the endocytic pathway for reabsorption of LMW proteins in the proximal tubule. This review will provide an overview of the important phenotypic characteristics of Dent's disease and summarize the molecular data that have significantly increased our comprehension of the mechanisms causing this disease.
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Affiliation(s)
- Félix Claverie-Martín
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
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Abstract
Dent's disease is a renal tubular disorder characterized by manifestations of proximal tubule dysfunction, including low-molecular-weight proteinuria, hypercalciuria, nephrolithiasis, nephrocalcinosis, and progressive renal failure. These features are generally found in males only, and may be present in early childhood, whereas female carriers may show a milder phenotype. Prevalence is unknown; the disorder has been reported in around 250 families to date. Complications such as rickets or osteomalacia may occur. The disease is caused by mutations in either the CLCN5 (Dent disease 1) or OCRL1 (Dent disease 2) genes that are located on chromosome Xp11.22 and Xq25, respectively. CLCN5 encodes the electrogenic Cl⁻/H(+) exchanger ClC-5, which belongs to the CLC family of Cl⁻ channels/transporters. OCRL1 encodes a phosphatidylinositol bisphosphate (PIP₂) 5-phosphatase and mutations are also associated with Lowe Syndrome. The phenotype of Dent's disease is explained by the predominant expression of ClC-5 in the proximal tubule segments of the kidney. No genotype-phenotype correlation has been described thus far, and there is considerable intra-familial variability in disease severity. A few patients with Dent's disease do not harbour mutations in CLCN5 and OCRL1, pointing to the involvement of other genes. Diagnosis is based on the presence of all three of the following criteria: low-molecular-weight proteinuria, hypercalciuria and at least one of the following: nephrocalcinosis, kidney stones, hematuria, hypophosphatemia or renal insufficiency. Molecular genetic testing confirms the diagnosis. The differential diagnosis includes other causes of generalized dysfunction of the proximal tubules (renal Fanconi syndrome), hereditary, acquired, or caused by exogenous substances. Antenatal diagnosis and pre-implantation genetic testing is not advised. The care of patients with Dent's disease is supportive, focusing on the treatment of hypercalciuria and the prevention of nephrolithiasis. The vital prognosis is good in the majority of patients. Progression to end-stage renal failure occurs between the 3rd and 5th decades of life in 30-80% of affected males.
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Affiliation(s)
- Olivier Devuyst
- Division of Nephrology, Université catholique de Louvain Medical School, Brussels, Belgium.
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Bökenkamp A, Böckenhauer D, Cheong HI, Hoppe B, Tasic V, Unwin R, Ludwig M. Dent-2 disease: a mild variant of Lowe syndrome. J Pediatr 2009; 155:94-9. [PMID: 19559295 DOI: 10.1016/j.jpeds.2009.01.049] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/02/2008] [Accepted: 01/15/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the renal and extra-renal phenotypes of patients classified as having Dent disease, Dent-2 disease, or Lowe syndrome. STUDY DESIGN Chart review of data from 93 patients with identified voltage-gated chloride channel and chloride/proton antiporter 5 gene and oculo-cerebro-renal syndrome of Lowe gene mutations observed by the authors, complemented with published data. RESULTS There was a wide overlap of renal symptoms. Nephrocalcinosis was more prevalent in Dent-1 disease, and renal tubular acidosis, aminoaciduria, and renal failure was more prevalent in patients with Lowe syndrome. Patients with Lowe syndrome were shorter than patients with Dent-1 disease, and patients with Dent-2 disease showed an intermediate phenotype. Three patients with Dent-2 disease had mild peripheral cataract, and 9 patients were noted to have some degree of mental retardation. CONCLUSION There is a phenotypic continuum within patients with Dent-2 disease and Lowe syndrome, suggesting that there are individual differences in the ability to compensate for loss of oculo-cerebro-renal syndrome of Lowe gene function.
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Affiliation(s)
- Arend Bökenkamp
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Blanchard A, Vargas-Poussou R, Peyrard S, Mogenet A, Baudouin V, Boudailliez B, Charbit M, Deschesnes G, Ezzhair N, Loirat C, Macher MA, Niaudet P, Azizi M. Effect of hydrochlorothiazide on urinary calcium excretion in dent disease: an uncontrolled trial. Am J Kidney Dis 2008; 52:1084-95. [PMID: 18976849 DOI: 10.1053/j.ajkd.2008.08.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 08/01/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Thiazide doses equivalent to 1 to 2 mg/kg/d of hydrochlorothiazide (HCTZ) have been proposed to correct hypercalciuria and prevent kidney failure in patients with Dent disease. However, they can cause adverse metabolic effects in the long term. In treating hypertension in children, lower thiazide doses have been shown to be as effective and well tolerated. STUDY DESIGN Uncontrolled trial, with forced-titration sequential open-label study design. SETTING & PARTICIPANTS 7 boys with genetically confirmed Dent disease and mild phenotype (neither overt sodium wasting nor kidney failure). INTERVENTION After a 1-month run-in period, patients sequentially received amiloride (5 mg/d) alone (1 month) and then for 3 periods of 2 months in association with increasing doses of HCTZ (<0.2, 0.2 to 0.4, and 0.4 to 0.8 mg/kg/d). OUTCOMES Urinary calcium excretion and extracellular volume indicators. MEASUREMENTS At the end of each period, 2 daily 24-hour urinary collections were performed on the days preceding admission. Blood and spot urine samples also were collected. RESULTS A greater HCTZ dose increased renin, aldosterone, and plasma protein concentrations. Amiloride alone had no effect on calcium excretion. The greatest HCTZ doses decreased spot urinary calcium excretion by 42% compared with baseline (median, 0.3; minimum, maximum, 0.2, 0.8 versus median, 0.8; minimum, maximum, 0.4, 1.1, respectively; P = 0.03). However, patients developed adverse reactions, including muscle cramps (n = 2), biological (n = 7) or symptomatic hypovolemia (n = 1), hypokalemia (n = 4), and hyponatremia (n = 1), which all corrected after treatment withdrawal. LIMITATION Small sample size and absence of a control group. CONCLUSION HCTZ doses greater than 0.4 mg/kg/d decreased calcium excretion, but were associated with significant adverse events. Thiazide diuretic therapy should be considered with caution in children with Dent disease.
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Affiliation(s)
- Anne Blanchard
- Université Paris 5, Faculté de Médecine Paris Descartes, Paris, France.
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Bockenhauer D, Bokenkamp A, van't Hoff W, Levtchenko E, Kist-van Holthe JE, Tasic V, Ludwig M. Renal phenotype in Lowe Syndrome: a selective proximal tubular dysfunction. Clin J Am Soc Nephrol 2008; 3:1430-6. [PMID: 18480301 DOI: 10.2215/cjn.00520108] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Lowe syndrome is defined by congenital cataracts, mental retardation, and proximal tubulopathy and is due to mutations in OCRL. Recently, mutations in OCRL were found to underlie some patients with Dent disease, characterized by low molecular weight proteinuria, hypercalciuria, and nephrocalcinosis. This phenotypic heterogeneity is poorly understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The renal phenotype of 16 patients with Lowe syndrome (10.9 +/- 7.0 yr) under care of the authors was characterized to define overlap of symptoms with Dent disease and infer clues about OCRL function. Medical charts of patients were reviewed for data regarding glomerular filtration rate and markers of proximal tubular function. RESULTS All patients had low molecular weight proteinuria and albuminuria. Lysosomal enzymuria was elevated in all 11 patients assessed. Fifteen patients had hypercalciuria, and 14 aminoaciduria. Seven patients required bicarbonate and three required phosphate replacement; all others maintained normal serum values without supplementation. None of the patients had detectable glycosuria, and none had clinically overt rickets. GFR was mildly to moderately impaired and highly variable, with a trend of deterioration with age. CONCLUSIONS Patients with Lowe syndrome do not have renal Fanconi syndrome but a selective proximal tubulopathy, variable in extent and dominated by low molecular weight proteinuria and hypercalciuria, the classical features of Dent disease. These findings suggest that OCRL and ClC-5, the chloride channel mutated in Dent disease, are involved in similar reabsorption pathways in the proximal tubule.
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Affiliation(s)
- Detlef Bockenhauer
- Department of Nephrology, Great Ormond Street Hospital, London, United Kingdom.
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Camerino DC, Desaphy JF, Tricarico D, Pierno S, Liantonio A. Therapeutic Approaches to Ion Channel Diseases. ADVANCES IN GENETICS 2008; 64:81-145. [DOI: 10.1016/s0065-2660(08)00804-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Utsch B, Bökenkamp A, Benz MR, Besbas N, Dötsch J, Franke I, Fründ S, Gok F, Hoppe B, Karle S, Kuwertz-Bröking E, Laube G, Neb M, Nuutinen M, Ozaltin F, Rascher W, Ring T, Tasic V, van Wijk JAE, Ludwig M. Novel OCRL1 mutations in patients with the phenotype of Dent disease. Am J Kidney Dis 2007; 48:942.e1-14. [PMID: 17162149 DOI: 10.1053/j.ajkd.2006.08.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 08/24/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dent disease is an X-linked tubulopathy frequently caused by mutations affecting the voltage-gated chloride channel and chloride/proton antiporter ClC-5. A recent study showed that defects in OCRL1, encoding a phosphatidylinositol 4,5-bisphosphate 5-phosphatase (Ocrl) and usually found mutated in patients with Lowe syndrome, also can provoke a Dent-like phenotype (Dent 2 disease). METHODS We investigated 20 CLCN5-negative males from 17 families with a phenotype resembling Dent disease for defects in OCRL1. RESULTS In our complete series of 35 families with a phenotype of Dent disease, a mutation in the OCRL1 gene was detected in 6 kindreds. All were novel frameshift (Q70RfsX88 and T121NfsX122, detected twice) or missense mutations (I257T and R476W). None of our patients had cognitive or behavioral impairment or cataracts, 2 classic hallmarks of Lowe syndrome. All patients had mild increases in lactate dehydrogenase and/or creatine kinase levels, which rarely is observed in CLCN5-positive patients, but frequently found in patients with Lowe syndrome. To explain the phenotypic heterogeneity caused by OCRL1 mutations, we performed extensive data-bank mining and extended reverse-transcriptase polymerase chain reaction analysis, which provided no evidence for yet unknown (tissue-specific) alternative OCRL1 transcripts. CONCLUSION Mutations in the OCRL1 gene are found in approximately 23% of kindreds with a Dent phenotype. Defective protein sorting/targeting of Ocrl might be the reason for mildly elevated creatine kinase and lactate dehydrogenase serum concentrations in these patients and a clue to suspect Dent disease unrelated to CLCN5 mutations. It remains to be elucidated why the various OCRL1 mutations found in patients with Dent 2 disease do not cause cataracts.
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Affiliation(s)
- Boris Utsch
- Klinik mit Poliklinik für Kinder und Jugendliche, Universität Erlangen-Nürnberg, Erlangen, Germany
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Ludwig M, Utsch B, Monnens LAH. Recent advances in understanding the clinical and genetic heterogeneity of Dent's disease. Nephrol Dial Transplant 2006; 21:2708-17. [PMID: 16861240 DOI: 10.1093/ndt/gfl346] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Michael Ludwig
- Department of Clinical Biochemistry, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany.
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