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Lai X, Lu S, Jiang J, Zhang H, Yang Q, Liu Y, Li L, Li S, Dai S, Chen Y, Chen Y, Liu J, Li Y. Association of polymorphisms of calcium reabsorption genes SLC12A1, KCNJ1 and SLC8A1 with colorectal adenoma. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04773-4. [PMID: 37074453 PMCID: PMC10374786 DOI: 10.1007/s00432-023-04773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND In recent years, morbidity and mortality from colorectal cancer have increased. Colorectal adenoma is the main precancerous lesion. Understanding the pathogenesis of colorectal adenoma will help to improve the early diagnosis rate of colorectal cancer. METHODS In this case-control study, we focused on three single nucleotide polymorphisms (SNPs) in genes SLC8A1 (rs4952490), KCNJ1 (rs2855798), and SLC12A1 (rs1531916). We analyzed 207 colorectal adenoma patients (112 high-risk cases and 95 low-risk cases) and 212 control subjects by Sanger sequencing. A food frequency questionnaire (FFQ) was used to survey demographic characteristics and dietary nutrition. RESULTS In the overall analysis, the results suggested that the AA+AG and AG genotype carriers of rs4952490 had a 73.1% and 78% lower risk of colorectal adenoma compared to GG genotype carriers, respectively. However rs2855798 and rs1531916 were not associated with the incidence of colorectal adenoma. Additionally, stratified analysis showed that rs4952490 AA+AG and AG genotypes had a protective effect against low-risk colorectal adenoma in patients aged ≤ 60 years old who were non-smokers. We also observed that when calcium intake was higher than 616 mg/d and patients carried at least one gene with variant alleles there was a protective effect against low-risk colorectal adenoma. CONCLUSIONS Interactions between dietary calcium intake and calcium reabsorption genes may affect the occurrence and development of colorectal adenoma.
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Affiliation(s)
- Xiaolian Lai
- Department of Gastroenterology, People's Hospital of Songtao Miao Autonomous County, Tongren, China
| | - Shuoyan Lu
- Department of Gastroenterology, People's Hospital of Songtao Miao Autonomous County, Tongren, China
| | - Jia Jiang
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Hanqun Zhang
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qinglin Yang
- Department of Preventive Medicine, School of Public Health at Zunyi Medical University, Zunyi, China
| | - Yuncong Liu
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Libo Li
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Sanming Li
- Department of Gastroenterology, People's Hospital of Songtao Miao Autonomous County, Tongren, China
| | - Si Dai
- Department of Gastroenterology, People's Hospital of Songtao Miao Autonomous County, Tongren, China
| | - Yanping Chen
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Chen
- People's Hospital of Fenggang County, Zunyi, China
| | - Jun Liu
- Department of Preventive Medicine, School of Public Health at Zunyi Medical University, Zunyi, China.
| | - Yong Li
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, China.
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Yıldız G, Torun Bayram M, Çinleti T, Koç A, Soylu A, Kavukçu S. Late onset Bartter syndrome: Bartter syndrome type 2 presenting with isolated nephrocalcinosis and high parathyroid hormone levels mimicking primary hyperparathyroidism. J Pediatr Endocrinol Metab 2022; 35:1298-1301. [PMID: 35952717 DOI: 10.1515/jpem-2022-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nephrocalcinosis is associated with conditions that cause hypercalcemia and the increased urinary excretion of calcium, phosphate, and/or oxalate. A monogenic etiology is found in almost 30% of childhood-onset nephrocalcinosis which is also a common manifestation of primary hyperparathyroidism. We discuss a child with nephrocalcinosis and features mimicking primary hyperparathyroidism. CASE PRESENTATION A 7-year-old girl presented with nephrocalcinosis. Hypercalciuria, hyperphosphaturia, mild hypercalcemia, hypophosphatemia and elevated parathyroid hormone levels along with normal serum creatinine and absence of hypokalemic alkalosis suggested primary hyperparathyroidism. However, she was ultimately diagnosed with Bartter syndrome type 2 based on the presence of homozygous pathogenic variation in KCNJ1gene. CONCLUSIONS This is the second reported case of late-onset Bartter syndrome type 2 without hypokalemic alkalosis. Patients with Bartter syndrome may present with high parathyroid hormone levels and hypercalcemia in addition to hypercalciuria. Thus, the present case suggests that the KCNJ1 gene should be included in genetic analysis even in older children with isolated nephrocalcinosis.
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Affiliation(s)
- Gizem Yıldız
- Department of Pediatric Nephrology, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Meral Torun Bayram
- Department of Pediatric Nephrology, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Tayfun Çinleti
- Department of Pediatric Genetic, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Altuğ Koç
- Department of Medical Genetics, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Alper Soylu
- Department of Pediatric Nephrology and Rheumatology, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Salih Kavukçu
- Department of Pediatric Nephrology and Rheumatology, Dokuz Eylül University Medical Faculty, Izmir, Turkey
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Tian M, Peng H, Bi X, Wang YQ, Zhang YZ, Wu Y, Zhang BR. Late-Onset Bartter Syndrome Type II Due to a Novel Compound Heterozygous Mutation in KCNJ1 Gene: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:862514. [PMID: 35463019 PMCID: PMC9021870 DOI: 10.3389/fmed.2022.862514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bartter syndrome (BS) type II is a rare autosomal recessive renal tubular disorder caused by mutations in the KCNJ1 gene, which encodes the apical renal outer medullary potassium (ROMK) channel in the thick ascending limb (TAL) of Henle’s loop. BS type II is typically considered as a disorder of infancy and seldom seen in adults. Case Presentation A 34-year-old woman was admitted with generalized body numbness and hand convulsions, without growth retardation. Laboratory tests revealed hypokalemic metabolic alkalosis, hyperreninemic hyperaldosteronism, and nephrocalcinosis. She was misdiagnosed during the initial diagnosis process and was finally diagnosed with late-onset BS type II via genetic testing through next-generation sequencing combined with Sanger sequencing. A novel compound heterozygous p.Leu207Ile/p. Cys308Arg variant in exon 5 of the KCNJ1 gene from her parents was identified and speculated to be a potential pathogenic gene variation. Conclusion We report a case of late-onset BS type II with a novel compound heterozygous mutation in KCNJ1. Both variants are novel and have never been reported. Our report will have a significant impact on the diagnosis of BS in other patients without typical clinical presentations and emphasizes the importance of genetic investigation.
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Affiliation(s)
- Mi Tian
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Peng
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Bi
- Guangzhou KingMed Center for Clinical Laboratory Co, Ltd., Guangzhou, China
| | - Yan-Qiu Wang
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yong-Zhe Zhang
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan Wu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bei-Ru Zhang
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Bei-Ru Zhang,
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4
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London S, Levine MA, Li D, Spiegel R, Lebel A, Halevy R, Tenenbaum-Rakover Y. Hypocalcemia as the Initial Presentation of Type 2 Bartter Syndrome: A Family Report. J Clin Endocrinol Metab 2022; 107:e1679-e1688. [PMID: 34751387 DOI: 10.1210/clinem/dgab821] [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: 09/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Bartter syndrome (BS) is a group of rare autosomal-recessive tubulopathies characterized by hypokalemic, hypochloremic metabolic alkalosis in which the primary defect is a deficiency of transporters involved in sodium chloride reabsorption. Type 2 BS results from a defect in the renal outer medullary potassium channel encoded by the KCNJ1 gene. Type 2 BS presents with polyhydramnios, intrauterine growth retardation, prematurity, failure to thrive, polyuria, hypercalciuria, and life-threatening episodes of dehydration. Hypocalcemia is a very rare presenting symptom of BS, with only a few published cases reporting it as the initial manifestation of type 2 BS. OBJECTIVE To describe a child who presented with hypocalcemic seizure at the age of 2.3 years that was first related to vitamin D deficiency and high-phosphate soft drink consumption. METHODS Whole exome sequencing (WES) was used to evaluate the biochemical abnormalities of the proband. RESULTS We identified a previously described homozygous missense mutation c.212C>T, p.T71M in the KCNJ1 gene associated with type 2 BS. Six additional family members with the same mutation and diagnosed clinically with BS are also reported, 2 presenting with hypocalcemia associated with vitamin D deficiency. CONCLUSION This report expands the clinical spectrum associated with KCNJ1 mutations and emphasizes the role of WES in unsolved cases of hypocalcemia when genetic disease is suspected. It also highlights the hazardous effects of phosphate-containing soft drinks on calcium metabolism.
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Affiliation(s)
- Shira London
- Pediatric Endocrine Institute, Ha'Emek Medical Center, Afula, Israel
- Armon Child Health Center, Clalit Health Services, Haifa, Israel
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Center for Bone Health, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ronen Spiegel
- Pediatric Ward B, Ha'Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Asaf Lebel
- The Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
- Pediatric Nephrology Unit, Ha'Emek Medical Center, Afula, Israel
| | - Rephael Halevy
- Pediatric Nephrology Unit, Ha'Emek Medical Center, Afula, Israel
| | - Yardena Tenenbaum-Rakover
- Pediatric Endocrine Institute, Ha'Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Saha A, Pande P, Vala K, Kapadia S, Patel H. Clinical exome sequencing uncovers an unsuspected diagnosis of Bartter syndrome type 2 in a child with incidentally detected nephrocalcinosis. CEN Case Rep 2022; 11:417-421. [PMID: 35195872 DOI: 10.1007/s13730-022-00694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 11/25/2022] Open
Abstract
Nephrocalcinosis is a characteristic feature of both type 1 and type 2 Bartter syndrome. Bartter syndrome type 2 presents antenatally and very early in life. Late-onset presentation with isolated nephrocalcinosis is extremely rare. We describe an 11-year-old girl with incidentally detected medullary nephrocalcinosis on renal ultrasonography. She was clinically suspected to have primary hyperoxaluria based on high urine oxalate. However, clinical exome sequencing revealed a pathogenic missense variant in the KCNJ1 gene leading to the molecular diagnosis of Bartter syndrome type 2. Both parents were heterozygous carriers of the same variant. Subsequent investigations did reveal a mild Bartter syndrome phenotype with mild metabolic alkalosis, high urine chloride and high renin and aldosterone. Our case illustrates phenotypic heterogeneity of Bartter syndrome type 2 and the usefulness of genetic testing in establishing the correct diagnosis and guiding further management in such cases.
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Affiliation(s)
- Anshuman Saha
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Gujarat University of Transplantation Sciences, Asarwa, Ahmedabad, Gujarat, 380016, India.
| | - Priyadarshini Pande
- Med Genome Labs Ltd, 3rd Floor, Narayana Netralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Rd, Bengaluru, Karnataka, 560099, India
| | - Kinnari Vala
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Gujarat University of Transplantation Sciences, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Shahenaz Kapadia
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Gujarat University of Transplantation Sciences, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Gujarat University of Transplantation Sciences, Asarwa, Ahmedabad, Gujarat, 380016, India
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Gorvin CM. Genetic causes of neonatal and infantile hypercalcaemia. Pediatr Nephrol 2022; 37:289-301. [PMID: 33990852 PMCID: PMC8816529 DOI: 10.1007/s00467-021-05082-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022]
Abstract
The causes of hypercalcaemia in the neonate and infant are varied, and often distinct from those in older children and adults. Hypercalcaemia presents clinically with a range of symptoms including failure to thrive, poor feeding, constipation, polyuria, irritability, lethargy, seizures and hypotonia. When hypercalcaemia is suspected, an accurate diagnosis will require an evaluation of potential causes (e.g. family history) and assessment for physical features (such as dysmorphology, or subcutaneous fat deposits), as well as biochemical measurements, including total and ionised serum calcium, serum phosphate, creatinine and albumin, intact parathyroid hormone (PTH), vitamin D metabolites and urinary calcium, phosphate and creatinine. The causes of neonatal hypercalcaemia can be classified into high or low PTH disorders. Disorders associated with high serum PTH include neonatal severe hyperparathyroidism, familial hypocalciuric hypercalcaemia and Jansen's metaphyseal chondrodysplasia. Conditions associated with low serum PTH include idiopathic infantile hypercalcaemia, Williams-Beuren syndrome and inborn errors of metabolism, including hypophosphatasia. Maternal hypocalcaemia and dietary factors and several rare endocrine disorders can also influence neonatal serum calcium levels. This review will focus on the common causes of hypercalcaemia in neonates and young infants, considering maternal, dietary, and genetic causes of calcium dysregulation. The clinical presentation and treatment of patients with these disorders will be discussed.
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Affiliation(s)
- Caroline M. Gorvin
- Institute of Metabolism and Systems Research and Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, B15 2TT UK ,Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Birmingham, B15 2TT UK
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7
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Zuo J, Guo W, Wang S, Lang Y, Wang S, Shi X, Zhang R, Zhao X, Han Y, Shao L. Eight novel KCNJ1 variants and parathyroid hormone overaction or resistance in 5 probands with Bartter syndrome type 2. Clin Chim Acta 2020; 511:248-254. [PMID: 33058840 DOI: 10.1016/j.cca.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 10/02/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Bartter syndrome type 2 (BS2) is an autosomal recessive renal tubular disorder, which is caused by the mutations in KCNJ1. This study was designed to analyze and describe the genotype and clinical features of five Chinese probands with BS2. METHODS Identify KCNJ1 gene variants by the next generation sequencing and evaluate their mutation effects according to 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines. RESULTS Ten variants including eight novel ones of KCNJ1 gene were found, the most common type was missense variant. The common symptoms and signs from high to low incidence were: polydipsia and polyuria (5/5), one of them (1/5) presented with diabetes insipidus; maternal polyhydramnios and premature delivery (4/5); growth retardation (3/5). Two patients presented with hypochloremic metabolic alkalosis and hypokalemia; whereas the acid-base disturbance was absent in the others. One patient had evident parathyroid hormone (PTH) resistance (hypocalcemia, hyperphosphatemia and markedly elevated PTH levels), three presented with PTH overacting (hypercalcemia, hypophosphatemia and mild elevated PTH levels), and one showed normal blood calcium and phosphorus concentrations with high-normal PTH levels. All patients had nephrocalcinosis and/or hypercalciuria, and one of them complicated with nephrolithiasis. Indomethacin has significant therapeutic effect on the growth retardation, polydipsia and polyuria and treatment was associated with a decrease in urine calcium excretion, normalization of electrolyte disturbance and PTH parameters. CONCLUSIONS Ten variants of KCNJ1 gene were identified in five Chinese probands. These patients had atypical BS phenotype lacking evident metabolic alkalosis and/or manifesting with PTH overaction/resistance, which reminds clinicians to carefully differentiate BS2 with other parathyroid disorders. This is the first report of BS2 from Chinese populations.
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Affiliation(s)
- Jianxin Zuo
- Department of Obstetrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China
| | - Wencong Guo
- Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Shandong University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Shujuan Wang
- Department of Nursing, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Yanhua Lang
- Department of Nursing, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Sai Wang
- Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Shandong University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Xiaomeng Shi
- Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Shandong University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Ruixiao Zhang
- Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Shandong University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Xiangzhong Zhao
- Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Yue Han
- Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Shandong University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China.
| | - Leping Shao
- Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Department of Nephrology, the Affiliated Qingdao Municipal Hospital of Shandong University, No.5 Donghai Middle Road, Qingdao 266071, People's Republic of China; Central Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China.
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Elfert KA, Geller DS, Nelson-Williams C, Lifton RP, Al-Malki H, Nauman A. Late-Onset Bartter Syndrome Type II Due to a Homozygous Mutation in KCNJ1 Gene: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924527. [PMID: 32997650 PMCID: PMC7534490 DOI: 10.12659/ajcr.924527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bartter syndrome is a rare genetic disease characterized by hypokalemia, metabolic alkalosis, and hyperreninemic hyperaldosteronism. Five different subtypes have been described based on the genetic defect identified. Bartter syndrome type II is caused by homozygous or compound heterozygous loss-of-function mutations in the KCNJ1 gene encoding ROMK. This subtype is typically described as a severe antenatal form of the disease, often presenting with polyhydramnios before childbirth. CASE REPORT Here, we describe the case of a 26-year-old man who presented with generalized body weakness and hypokalemia and was ultimately diagnosed with Bartter syndrome type II based on his clinical features coupled with the identification of a homozygous missense mutation in KCNJ1. CONCLUSIONS To the best of our knowledge, this is the fifth case of late-onset Bartter syndrome type II. Interestingly, the mutation identified in our patient has been previously described in patients with antenatal Bartter's Syndrome. The late presentation in our patient suggests a surprising degree of phenotypic variability, even in patients carrying the identical disease-causing mutation.
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Affiliation(s)
- Khaled A Elfert
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - David S Geller
- Department of Nephrology, Yale University School of Medicine, New Haven, CT, USA.,Department of Nephrology, West Haven VA Hospital, West Haven, CT, USA
| | | | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Hassan Al-Malki
- Department of Nephrology, Hamad Medical Corporation, Doha, Qatar
| | - Awais Nauman
- Department of Nephrology, Hamad Medical Corporation, Doha, Qatar
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Urinary Extracellular Vesicles and Salt-Losing Tubulopathies: A Proteomic Approach. Proteomes 2020; 8:proteomes8020009. [PMID: 32397528 PMCID: PMC7355747 DOI: 10.3390/proteomes8020009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
Renal tubular cells release urinary extracellular vesicles (uEV) that are considered a promising source of molecular markers for renal dysfunction and injury. We investigated uEV proteomes of patients with hereditary salt-losing tubulopathies (SLTs), focusing on those caused by Gitelman and Bartter (BS) syndromes, to provide potential markers for differential diagnosis. Second morning urine was collected from patients with genetically proven SLTs and uEV were isolated by the ultracentrifugation-based protocol. The uEV proteome was run through a diagonal bidimensional electrophoresis (16BAC/SDS-PAGE), to improve hydrophobic protein resolution. Sixteen differential spots from the proteome of two variants (BS2 and BS3) were analysed by nLC-ESI-MS/MS after in-gel tryptic digestion. A total of 167 protein species were identified from 7 BS2 spots and 9 BS3 spot. Most of these proteins were membrane-associated proteins, in particular transmembrane proteins, and were related to typical renal functions. The differential content of some uEV was then validated by immunoblotting. Our work suggests that uEV proteomics represents a promising strategy for the identification of differential SLT proteins. This could play a role in understanding the pathophysiological disease mechanisms and may support the recognition of different syndromes.
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10
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Nozu K, Yamamura T, Horinouchi T, Nagano C, Sakakibara N, Ishikura K, Hamada R, Morisada N, Iijima K. Inherited salt-losing tubulopathy: An old condition but a new category of tubulopathy. Pediatr Int 2020; 62:428-437. [PMID: 31830341 DOI: 10.1111/ped.14089] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/11/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022]
Abstract
Bartter syndrome (BS) and Gitelman syndrome (GS) are syndromes associated with congenital tubular dysfunction, characterized by hypokalemia and metabolic alkalosis. Clinically, BS is classified into two types: the severe antenatal/neonatal type, which develops during the fetal period with polyhydramnios and preterm delivery; and the relatively mild classic type, which is usually found during infancy with failure to thrive. GS can be clinically differentiated from BS by its age at onset, usually after school age, or laboratory findings of hypomagnesemia and hypocalciuria. Recent advances in molecular biology have shown that these diseases can be genetically classified into type 1 to 5 BS and GS. As a result, it has become clear that the clinical classification of antenatal/neonatal BS, classic BS, and GS does not always correspond to the clinical symptoms associated with the genotypes in a one-to-one manner; and there is clinically no clear differential border between type 3 BS and GS. This has caused confusion among clinicians in the diagnosis of these diseases. It has been proposed that the disease name "inherited salt-losing tubulopathy" can be used for cases of tubulopathies accompanied by hypokalemia and metabolic alkalosis. It is reasonable to use this term prior to genetic typing into type 1-5 BS or GS, to avoid confusion in a clinical setting. In this article, we review causative genes and phenotypic correlations, diagnosis, and treatment strategies for salt-losing tubulopathy as well as the clinical characteristics of pseudo-BS/GS, which can also be called a "salt-losing disorder".
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Affiliation(s)
- Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomohiko Yamamura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - 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
| | - Nana Sakakibara
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Ishikura
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Naoya Morisada
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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Khandelwal P, Sabanadesan J, Sinha A, Hari P, Bagga A. Isolated nephrocalcinosis due to compound heterozygous mutations in renal outer medullary potassium channel. CEN Case Rep 2020; 9:232-236. [PMID: 32185747 DOI: 10.1007/s13730-020-00464-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
Identification of a monogenic etiology is possible in a proportion of patients with childhood-onset nephrolithiasis or nephrocalcinosis. Bartter syndrome (BS), a hereditary tubulopathy characterized by polyuria, hypokalemic alkalosis and growth retardation that rarely presents with isolated nephrocalcinosis. Patients with defect in renal outer medullary potassium channel, encoded by the KCNJ1 gene causing BS type 2, typically present during the neonatal period. We describe a 14-year-old girl with mild late-onset BS type 2 with reported pathogenic compound heterozygous variations in exon 2 of KCNJ1 (c.146G > A and c.657C > G). This patient presented with isolated medullary nephrocalcinosis due to hypercalciuria; absence of hypokalemia and metabolic alkalosis was unique. This case highlights the importance of screening the KCNJ1 gene in patients with hypercalciuria and nephrocalcinosis, even in older children.
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Affiliation(s)
- Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Jasintha Sabanadesan
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Li J, Hu S, Nie Y, Wang R, Tan M, Li H, Zhu S. A novel compound heterozygous KCNJ1 gene mutation presenting as late-onset Bartter syndrome: Case report. Medicine (Baltimore) 2019; 98:e16738. [PMID: 31441846 PMCID: PMC6716717 DOI: 10.1097/md.0000000000016738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Bartter syndrome is an autosomal-recessive inherited disease in which patients present with hypokalemia and metabolic alkalosis. We present 1 case with Bartter syndrome, due to a novel compound heterozygous mutation in the KCNJ1 gene encoding the ATP-sensitive inward rectifier potassium channel in the thick ascending limb of the loop of Henle. PATIENT CONCERNS A patient was admitted to our hospital because of weakness, polyuria, and polydipsia. At presentation to our hospital, the female Chinese patient was 34 years old and her physical examination was normal. Laboratory studies revealed hypokalemia, metabolic alkalosis, hypercalciuria, hyperparathyroidemia, and hyper-reninemia. In addition, urinary potassium was obviously higher. Computer tomography scan confirmed the patient had the bilateral medullary nephrocalcinosis. DIAGNOSIS Blood samples were received from the patient and her parents, and deoxyribonucleic acid was extracted. The genetic analysis of SLC12A1, SLC12A3, KCNJ1, CLCNKB, BSND, and CASR was performed. The compound heterozygous KCNJ1 gene mutation was validated using conventional Sanger sequencing methods. INTERVENTIONS The patient was treated with potassium supplementation. Her blood and urine chemistries improved over the next week. Serum potassium normalized with improvement in polyuria and polydipsia over the next month. OUTCOMES Our patient was compound heterozygous for Thr234Ile and Thr71Met in the KCNJ1 gene. The c.701C>T variant predicted a change from a threonine codon to an isoleucine codon (p.Thr234Ile). The c.212C>T variant predicted a change from a threonine codon to a methionine codon (p.Thr71Met). The unaffected mother was heterozygous for the Thr234Ile mutation, whereas unaffected father was heterozygous for the Thr71Met mutation. LESSONS The phenotypes of the patient were similar to other patients with Bartter syndrome. The phenotypes of the patient could eventually be explained by the presence of the novel compound heterozygous p.Thr234Ile/p.Thr71Met variants in the KCNJ1 gene.
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Affiliation(s)
- Jingyi Li
- Department of Endocrinology, The First Affiliated Hospital, Tsinghua University
| | - Shoulong Hu
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University
| | - Yi Nie
- Department of Endocrinology, The First Affiliated Hospital, Tsinghua University
| | - Rongfeng Wang
- Department of Radiology, The First Affiliated Hospital, Tsinghua University, Beijing, P.R. China
| | - Ming Tan
- Department of Endocrinology, The First Affiliated Hospital, Tsinghua University
| | - Hongmei Li
- Department of Endocrinology, The First Affiliated Hospital, Tsinghua University
| | - Shuanli Zhu
- Department of Endocrinology, The First Affiliated Hospital, Tsinghua University
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13
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Kleta R, Bockenhauer D. Salt-Losing Tubulopathies in Children: What's New, What's Controversial? J Am Soc Nephrol 2018; 29:727-739. [PMID: 29237739 PMCID: PMC5827598 DOI: 10.1681/asn.2017060600] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Renal tubulopathies provide insights into the inner workings of the kidney, yet also pose therapeutic challenges. Because of the central nature of sodium in tubular transport physiology, disorders of sodium handling may affect virtually all aspects of the homeostatic functions of the kidney. Yet, owing to the rarity of these disorders, little clinical evidence regarding treatment exists. Consequently, treatment can vary widely between individual physicians and centers and is based mainly on understanding of renal physiology, reported clinical observations, and individual experiences. Salt-losing tubulopathies can affect all tubular segments, from the proximal tubule to the collecting duct. But the more frequently observed disorders are Bartter and Gitelman syndrome, which affect salt transport in the thick ascending limb of Henle's loop and/or the distal convoluted tubule, and these disorders generate the greatest controversies regarding management. Here, we review clinical and molecular aspects of salt-losing tubulopathies and discuss novel insights provided mainly by genetic investigations and retrospective clinical reviews. Additionally, we discuss controversial topics in the management of these disorders to highlight areas of importance for future clinical trials. International collaboration will be required to perform clinical studies to inform the treatment of these rare disorders.
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Affiliation(s)
- Robert Kleta
- UCL Centre for Nephrology and Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Detlef Bockenhauer
- UCL Centre for Nephrology and Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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14
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Zhao J, Zhu X, Shrubsole MJ, Ness RM, Hibler EA, Cai Q, Long J, Chen Z, Jiang M, Kabagambe EK, Zhang B, Hou L, Smalley WE, Edwards TL, Giovannucci EL, Zheng W, Dai Q. Interactions between calcium intake and polymorphisms in genes essential for calcium reabsorption and risk of colorectal neoplasia in a two-phase study. Mol Carcinog 2017; 56:2258-2266. [PMID: 28544176 DOI: 10.1002/mc.22678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 05/09/2017] [Accepted: 05/19/2017] [Indexed: 12/31/2022]
Abstract
The SLC8A1 (solute carrier family 8, member 1) gene, encoding Na+ /Ca2+ exchanger, is essential in regulating calcium reabsorption and homeostasis. Calcium homeostasis plays a key role in cell proliferation and apoptosis. We hypothesized that polymorphisms in five calcium-regulating genes (SLC8A1, ATP2B1, CALB1, CALB2, and CABP1) interact with calcium intake in relation to the risk of colorectal neoplasia. A two-phase (discovery and replication) study was conducted within the Tennessee Colorectal Polyp Study, including a total of 1275 cases and 2811 controls. In Phase I, we identified six out of 135 SNPs that significantly interacted with calcium intake in relation to adenoma risk. In Phase II, the calcium intake by rs4952490 (SLC8A1) interaction was replicated (Pinteraction = 0.048). We found an inverse association between calcium intake (1000-2000 mg/day) and colorectal adenomas, particularly for multiple/advanced adenomas, among the G-allele carriers but not among homozygous carriers of the common variant (A) in rs4952490. In the joint analysis of SLC8A1, KCNJ1, and SLC12A1 SNPs, carriers of variant alleles in at least two genes and with calcium intake above the DRI (1000 mg/day) were approximately 30-57% less likely to have adenomas than those whose calcium intake was below the DRI. The association was stronger for multiple/advanced adenomas. No association was found among those who did not carry any variant alleles in these genes when calcium intake was below 2500 mg/day. These findings, if confirmed, may provide a new avenue for the personalized prevention of colorectal adenoma and cancer.
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Affiliation(s)
- Jing Zhao
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Xiangzhu Zhu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee.,Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Reid M Ness
- Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elizabeth A Hibler
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zhi Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ming Jiang
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Laboratory of Nuclear Receptors and Cancer Research, Center for Basic Medical Research, School of Medicine, Nantong University, Jiangsu, China
| | - Edmond K Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Bing Zhang
- Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Walter E Smalley
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee.,Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Edward L Giovannucci
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee.,Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Qi Dai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee.,Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
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15
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Gollasch B, Anistan YM, Canaan-Kühl S, Gollasch M. Late-onset Bartter syndrome type II. Clin Kidney J 2017; 10:594-599. [PMID: 28979772 PMCID: PMC5622898 DOI: 10.1093/ckj/sfx033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/27/2017] [Indexed: 02/07/2023] Open
Abstract
Mutations in the ROMK1 potassium channel gene (KCNJ1) cause antenatal/neonatal Bartter syndrome type II (aBS II), a renal disorder that begins in utero, accounting for the polyhydramnios and premature delivery that is typical in affected infants, who develop massive renal salt wasting, hypokalaemic metabolic alkalosis, secondary hyperreninaemic hyperaldosteronism, hypercalciuria and nephrocalcinosis. This BS type is believed to represent a disorder of the infancy, but not in adulthood. We herein describe a female patient with a remarkably late-onset and mild clinical manifestation of BS II with compound heterozygous KCNJ1 missense mutations, consisting of a novel c.197T > A (p.I66N) and a previously reported c.875G > A (p.R292Q) KCNJ1 mutation. We implemented and evaluated the performance of two different bioinformatics-based approaches of targeted massively parallel sequencing [next generation sequencing (NGS)] in defining the molecular diagnosis. Our results demonstrate that aBS II may be suspected in patients with a late-onset phenotype. Our experimental approach of NGS-based mutation screening combined with Sanger sequencing proved to be a reliable molecular approach for defining the clinical diagnosis in our patient, and results in important differential diagnostic and therapeutic implications for patients with BS. Our results could have a significant impact on the diagnosis and methodological approaches of genetic testing in other patients with clinical unclassified phenotypes of nephrocalcinosis and congenital renal electrolyte abnormalities.
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Affiliation(s)
- Benjamin Gollasch
- Franz Volhard Clinical Research Center at the Experimental and Clinical Research Center (ECRC), a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association of National Research Centers, Berlin, Germany
| | - Yoland-Marie Anistan
- Experimental and Clinical Research Center (ECRC), a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association of National Research Centers, Berlin, Germany
| | - Sima Canaan-Kühl
- Medical Clinic for Nephrology and Internal Intensive Care, Campus Virchow, Charité University Medicine, Berlin, Germany
| | - Maik Gollasch
- Experimental and Clinical Research Center (ECRC), a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association of National Research Centers, Berlin, Germany.,Medical Clinic for Nephrology and Internal Intensive Care, Campus Virchow, Charité University Medicine, Berlin, Germany
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16
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Accentuated hyperparathyroidism in type II Bartter syndrome. Pediatr Nephrol 2016; 31:1085-90. [PMID: 26857709 DOI: 10.1007/s00467-016-3337-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bartter syndrome (BS) may be associated with different degrees of hypercalciuria, but marked parathyroid hormone (PTH) abnormalities have not been described. METHODS We compared clinical and laboratory data of patients with either ROMK-deficient type II BS (n = 14) or Barttin-deficient type IV BS (n = 20). RESULTS Only BS-IV patients remained mildly hypokalemic in spite of a higher need for potassium supplementation. Estimated glomerular filtration rate (eGFR) was mildly decreased in only four BS-IV patients. Average PTH values were significantly higher in BS-II (160.6 ± 85.8 vs. 92.5 ± 48 pg/ml in BS-IV, p = 0.006). In both groups, there was a positive correlation between age and log(PTH). Levels of 25(OH) vitamin D were not different. Total serum calcium was lower (within normal limits) and age-related serum phosphate (Pi)-SDS was increased in BS-II (1.19 ± 0.71 vs. 0.01 ± 1.04 in BS-IV, p < 0.001). The GFR threshold for Pi reabsorption was higher in BS-II (5.63 ± 1.25 vs. 4.36 ± 0.98, p = 0.002). Spot urine calcium/creatinine ratio and nephrocalcinosis rate (100 vs. 16 %) were higher in the BS-II group. CONCLUSIONS PTH, serum Pi levels, and urinary threshold for Pi reabsorption are significantly elevated in type II vs. type IV BS, suggesting a PTH resistance state. This may be a response to more severe long-standing hypercalciuria, leading to a higher rate of nephrocalcinosis in BS-II.
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17
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Zhu X, Liang J, Shrubsole MJ, Ness RM, Cai Q, Long J, Chen Z, Li G, Wiese D, Zhang B, Smalley WE, Edwards TL, Giovannucci E, Zheng W, Dai Q. Calcium intake and ion transporter genetic polymorphisms interact in human colorectal neoplasia risk in a 2-phase study. J Nutr 2014; 144:1734-41. [PMID: 25165391 PMCID: PMC4195417 DOI: 10.3945/jn.114.196709] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The kidney-specific sodium-potassium-chloride cotransporter (NKCC2) protein encoded by solute carrier family 12 member 1 (SLC12A1) is the direct downstream effector of the inward-rectifier potassium channel (ROMK) encoded by potassium inwardly-rectifying channel, subfamily J, member 1 (KCNJ1), both of which are critical for calcium reabsorption in the kidney. OBJECTIVE We hypothesized that polymorphisms in KCNJ1, SLC12A1, and 7 other genes may modify the association between calcium intake and colorectal neoplasia risk. METHODS We conducted a 2-phase study in 1336 cases and 2891 controls from the Tennessee Colorectal Polyp Study. RESULTS In phase I, we identified 5 single-nucleotide polymorphisms (SNPs) that significantly interacted with calcium intake in adenoma risk. In phase II, rs2855798 in KCNJ1 was replicated. In combined analysis of phases I and II, the P values for interactions between calcium intake and rs2855798 were 1 × 10(-4) for all adenoma and 5 × 10(-3) for multiple/advanced adenoma. The highest calcium intake was not associated with risk among those with no variant allele but was significantly associated with a 41% reduced adenoma risk among those who carried at least 1 variant allele in KCNJ1. The corresponding reduction in risk of multiple or advanced adenomas was 52% among those with at least 1 variant allele. The P values for interactions between calcium intake and combined SNPs from the KCNJ1 and SLC12A1 genes were 7.5 × 10(-5) for adenoma and 9.9 × 10(-5) for multiple/advanced adenoma. The highest calcium intake was not associated with risk among those with nonvariant alleles in 2 genes but was significantly associated with a 34% reduced adenoma risk among those who carried a variant allele in 1 of the genes. The corresponding reduction in risk of multiple or advanced adenomas was 64% among those with variant alleles in both genes. CONCLUSION These findings, if confirmed, will be critical for the development of personalized prevention strategies for colorectal cancer.
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Affiliation(s)
- Xiangzhu Zhu
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center, Nashville, TN
| | - Ji Liang
- Department of Maternal and Child Health, School of Public Health, Fudan University, Shanghai, China
| | - Martha J. Shrubsole
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center, Nashville, TN
| | - Reid M. Ness
- Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Qiuyin Cai
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and
| | - Jirong Long
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and
| | - Zhi Chen
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and
| | - Guoliang Li
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and
| | - Dawn Wiese
- Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Bing Zhang
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN; and
| | - Walter E. Smalley
- Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN;,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center, Nashville, TN
| | - Todd L. Edwards
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center, Nashville, TN
| | - Edward Giovannucci
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
| | - Wei Zheng
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and,Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center, Nashville, TN
| | - Qi Dai
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, and Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center, Nashville, TN;
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18
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Abu Raya B, Koren I, Bader D, Kugelman A, Borenstein-Levin L, Riskin A. Transient Hypercalcemia in Preterm Infants. Glob Pediatr Health 2014; 1:2333794X14560818. [PMID: 27335919 PMCID: PMC4804696 DOI: 10.1177/2333794x14560818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bahaa Abu Raya
- Technion, Israel Institute of Technology, Haifa, Israel
- Department of Pediatrics, B’nai-Zion Medical Center, Haifa, Israel
| | - Ilana Koren
- Technion, Israel Institute of Technology, Haifa, Israel
- Clalit Health Care Service, Haifa, Israel
| | - David Bader
- Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Kugelman
- Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Liron Borenstein-Levin
- Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Arieh Riskin
- Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
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19
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Deschênes G, Fila M. Primary molecular disorders and secondary biological adaptations in bartter syndrome. Int J Nephrol 2011; 2011:396209. [PMID: 21941653 PMCID: PMC3177086 DOI: 10.4061/2011/396209] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/01/2011] [Indexed: 12/17/2022] Open
Abstract
Bartter syndrome is a hereditary disorder that has been characterized by the association of hypokalemia, alkalosis, and the hypertrophy of the juxtaglomerular complex with secondary hyperaldosteronism and normal blood pressure. By contrast, the genetic causes of Bartter syndrome primarily affect molecular structures directly involved in the sodium reabsorption at the level of the Henle loop. The ensuing urinary sodium wasting and chronic sodium depletion are responsible for the contraction of the extracellular volume, the activation of the renin-aldosterone axis, the secretion of prostaglandins, and the biological adaptations of downstream tubular segments, meaning the distal convoluted tubule and the collecting duct. These secondary biological adaptations lead to hypokalemia and alkalosis, illustrating a close integration of the solutes regulation in the tubular structures.
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Affiliation(s)
- Georges Deschênes
- Pediatric Nephrology Unit, Hôpital Robert-Debré, 48 Bd Sérurier, 75019 Paris, France
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