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Pszczolinski R, Acquaviva C, Berrahal I, Biebuyck N, Burtey S, Clabault K, Dossier C, Guillet M, Hemery F, Letavernier E, Rousset-Rouvière C, Bacchetta J, Moulin B. Primary hyperoxaluria in adults and children: a nationwide cohort highlights a persistent diagnostic delay. Clin Kidney J 2024; 17:sfae099. [PMID: 38737343 PMCID: PMC11087826 DOI: 10.1093/ckj/sfae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Indexed: 05/14/2024] Open
Abstract
Background Primary hyperoxalurias (PH) are extremely rare genetic disorders characterized by clinical heterogeneity. Delay in diagnosing these conditions can have detrimental effects on patient outcomes. The primary objective of this study is to assess the current diagnostic delay for PH. Methods This nationwide, observational and retrospective study included patients who received a genetic diagnosis of PH types 1, 2 and 3 between 1 January 2015 and 31 December 2019. Diagnostic delay was defined as the duration between the onset of symptoms and the time of genetic diagnosis. Results A total of 52 patients (34 children and 18 adults) were included in the study, with 40 PH1 (77%), 3 PH2 (6%) and 9 PH3 (17%). At the time of diagnosis, 12 patients (23%) required dialysis. Among the PH1 patients, the predominant symptom at onset in adults was renal colic (79% of cases), whereas symptoms in children were more diverse (renal colic in 17% of cases). The diagnostic delay was significantly shorter in children compared with adults [median (interquartile range)]: 1.2 (0.1-3.0) versus 30 (17-36) years, respectively (P < .0001). RNA interference was utilized in 23 patients (58%). Five individuals (13%) underwent double liver-kidney transplantation, and five (13%) received isolated kidney transplantation, with lumasiran therapy in four patients. For PH2 and PH3 patients, the diagnostic delay ranges from 0 to 3 years, with renal colic as first symptom in 33% of cases. Conclusion This extensive and recent cohort of PH underscores the considerable delay in diagnosing PH, particularly in adults, even in a country with a dedicated organization for enhancing the overall management of rare diseases. These findings reinforce the imperative for increased awareness among relevant specialties regarding the evaluation of urolithiasis.
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Affiliation(s)
- Romain Pszczolinski
- Service de néphrologie-dialyse-transplantation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Cécile Acquaviva
- Service de biochimie et biologie moléculaire, CHU de Lyon HCL – GH Est, Lyon, France
| | | | - Nathalie Biebuyck
- Service de néphrologie pédiatrique, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Burtey
- Service de néphrologie et de transplantation rénale, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- C2VN, Aix-Marseille Université/INSERM/INRAE, Marseille, France
| | - Karine Clabault
- Service de néphrologie, Hôpital Privé de l'Estuaire, Le Havre, France
| | - Claire Dossier
- Service de néphrologie pédiatrique, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Guillet
- Service de néphrologie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Floriane Hemery
- Service de pédiatrie, CHU de Montpellier, Montpellier, France
| | - Emmanuel Letavernier
- Service d'Explorations fonctionnelles multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Rousset-Rouvière
- Service de pédiatrie multidisciplinaire, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Justine Bacchetta
- Service de néphrologie-rhumatologie-dermatologie pédiatriques, CHU de Lyon HCL – GH Est-Hôpital Femme Mère Enfant, Lyon, France
| | - Bruno Moulin
- Service de néphrologie-dialyse-transplantation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
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Tasian GE, Dickinson K, Park G, Marchesani N, Mittal A, Cheng N, Ching CB, Chu DI, Walton R, Yonekawa K, Gluck C, Muneeruddin S, Kan KM, DeFoor W, Rove K, Forrest CB. Distinguishing characteristics of pediatric patients with primary hyperoxaluria type 1 in PEDSnet. J Pediatr Urol 2024; 20:88.e1-88.e9. [PMID: 37848358 DOI: 10.1016/j.jpurol.2023.10.001] [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: 06/28/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) is an autosomal recessive inborn error of metabolism that causes oxalate deposition, leading to recurrent calcium oxalate kidney stones, chronic kidney disease and systemic oxalosis, which produces a broad range of serious life-threatening complications. Patients with PH1 have delayed diagnosis due to the rarity of the disease and the overlap with early-onset kidney stone disease not due to primary hyperoxaluria. OBJECTIVE The objective of this study was to determine the clinical features of individuals <21 years of age with PH1 that precede its diagnosis. We hypothesized that a parsimonious set of features could be identified that differentiate patients with PH1 from patients with non-primary hyperoxaluria-associated causes of early-onset kidney stone disease. STUDY DESIGN We determined the association between clinical characteristics and PH1 diagnosis in a case-control study conducted between 2009 and 2021 in PEDSnet, a clinical research network of eight US pediatric health systems. Each patient with genetically confirmed PH1 was matched by sex and PEDSnet institution to up to 4 control patients with kidney stones without PH of any type. We obtained patient characteristics and diagnostic test results occurring before to less than 6 months after study entrance from a centralized database query and from manual chart review. Differences were examined using standardized differences and multivariable regression. RESULTS The study sample included 37 patients with PH1 and 147 controls. Patients with PH1 were younger at diagnosis (median age of 3 vs 13.5 years); 75 % of children with PH1 were less than 8 years-old. Patients with PH1 were more likely to have combinations of nephrocalcinosis on ultrasound or CT (43 % vs 3 %), lower eGFR at diagnosis (median = 52 mL/min/1.73 m2 vs 114 mL/min/1.73 m2), and have normal mobility. Patients with PH1 had higher proportion of calcium oxalate monohydrate kidney stones than controls (median = 100 % vs 10 %). There were no differences in diagnosis of failure to thrive, stone size, or echocardiography results. CONCLUSIONS Children with PH1 are characterized by presentation before adolescence, nephrocalcinosis, decreased eGFR at diagnosis, and calcium oxalate monohydrate stone composition. If externally validated, these characteristics could facilitate earlier diagnosis and treatment of children with PH1.
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Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kimberley Dickinson
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Grace Park
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Marchesani
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - David I Chu
- Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ryan Walton
- Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Karyn Yonekawa
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Caroline Gluck
- Department of Pediatrics, Division of Nephrology, Nemours Children's Health, Wilmington, DE, USA
| | - Samina Muneeruddin
- Department of Pediatrics, Division of Nephrology, Nemours Children's Health, Wilmington, DE, USA
| | - Kathleen M Kan
- Department of Surgery, Division of Urology, Stanford University, Palo Alto, CA, USA
| | - William DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Kyle Rove
- Department of Pediatric Urology, Division of Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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3
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Ferraro PM, D'Ambrosio V, Gambaro G, Giachino D, Groothoff J, Mandrile G. A clinical screening algorithm for primary hyperoxaluria type 1 in adults on dialysis. Nephrol Dial Transplant 2024; 39:367-370. [PMID: 37708050 PMCID: PMC10828199 DOI: 10.1093/ndt/gfad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
| | - Viola D'Ambrosio
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Giachino
- Medical Genetic Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Giorgia Mandrile
- Genetic Unit and Thalassemia Center, San Luigi Gonzaga University Hospital, Torino, Italy
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Ching CB, Dickinson K, Karafilidis J, Marchesani N, Mucha L, Antunes N, Razzaghi H, Utidjian L, Yonekawa K, Coplen DE, Muneeruddin S, DeFoor W, Rove KO, Forrest CB, Tasian GE. The real world experience of pediatric primary hyperoxaluria patients in the PEDSnet clinical research network. Eur J Pediatr 2023; 182:4027-4036. [PMID: 37392234 DOI: 10.1007/s00431-023-05077-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
The rarity of primary hyperoxaluria (PH) challenges our understanding of the disease. The purpose of our study was to describe the course of clinical care in a United States cohort of PH pediatric patients, highlighting health service utilization. We performed a retrospective cohort study of PH patients < 18 years old in the PEDSnet clinical research network from 2009 to 2021. Outcomes queried included diagnostic imaging and testing related to known organ involvement of PH, surgical and medical interventions specific to PH-related renal disease, and select PH-related hospital service utilization. Outcomes were evaluated relative to cohort entrance date (CED), defined as date of first PH-related diagnostic code. Thirty-three patients were identified: 23 with PH type 1; 4 with PH type 2; 6 with PH type 3. Median age at CED was 5.0 years (IQR 1.4, 9.3 years) with the majority being non-Hispanic white (73%) males (70%). Median follow-up between CED and most recent encounter was 5.1 years (IQR 1.2, 6.8). Nephrology and Urology were the most common specialties involved in care, with low utilization of other sub-specialties (12%-36%). Most patients (82%) had diagnostic imaging used to evaluate kidney stones; 11 (33%) had studies of extra-renal involvement. Stone surgery was performed in 15 (46%) patients. Four patients (12%) required dialysis, begun in all prior to CED; four patients required renal or renal/liver transplant. Conclusion: In this large cohort of U.S. PH children, patients required heavy health care utilization with room for improvement in involving multi-disciplinary specialists. What is Known: • Primary hyperoxaluria (PH) is rare with significant implications on patient health. Typical involvement includes the kidneys; however, extra-renal manifestations occur. • Most large population studies describe clinical manifestations and involve registries. What is New: • We report the clinical journey, particularly related to diagnostic studies, interventions, multispecialty involvement, and hospital utilization, of a large cohort of PH pediatric patients in the PEDSnet clinical research network. • There are missed opportunities, particularly in that of specialty care, that could help in the diagnosis, treatment, and even prevention of known clinical manifestations.
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Affiliation(s)
- Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Kimberley Dickinson
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Nicole Marchesani
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Mucha
- Dicerna Pharmaceuticals, Cambridge, MA, USA
| | | | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Levon Utidjian
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karyn Yonekawa
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Douglas E Coplen
- Department of Surgery, Division of Urology, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Samina Muneeruddin
- Department of Pediatrics, Division of Nephrology, AI DuPont Children's Hospital, Wilmington, DE, USA
| | - William DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Healthcare Management, Perelman School of Medicineat the , University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Boussetta A, Fatnassi R, Jellouli M, Maamouri R, Mrad R, Gargah T, Omezzine A. Hyperoxalurie primitive de type 1: Particularités cliniques, génétiques
et évolutive chez l’enfant Tunisien. LA TUNISIE MEDICALE 2023; 101:626-630. [PMID: 38445424 PMCID: PMC11217970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/09/2023] [Indexed: 07/05/2024]
Abstract
INTRODUCTION There are three types of primary hyperoxaluria, with type 1 considered the most severe. AIM To analyze the clinical, genetic, and evolutionary characteristics of type 1 primary hyperoxaluria with pediatric onset. METHODS This was a retrospective, descriptive study that included Tunisian children under the age of 18 at the time of diagnosis over a period of 25 years (January 1, 1996, to December 31, 2022). RESULTS Thirty-five patients were included, with a mean age of 4.1 years. The most common presenting circumstances of the disease were nephrolithiasis and end-stage renal failure. The average serum creatinine level was 225.42 µmol/l. Five mutations were identified, with the p.Ile244Thr mutation being the most prevalent. Nephrocalcinosis, surgical intervention, and a creatinine level ≥57 µmol/l were predictive of progression to end-stage renal failure. The infantile form was predictive of mortality. CONCLUSIONS Screening for the disease would improve the prognosis of this condition.
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Affiliation(s)
- Abir Boussetta
- Department of Pediatric Nephrology, Charles Nicolle Hospital
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Rihab Fatnassi
- Department of Pediatric Nephrology, Charles Nicolle Hospital
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Manel Jellouli
- Department of Pediatric Nephrology, Charles Nicolle Hospital
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Rym Maamouri
- Department of Ophthalmology, Habib Thameur Hospital
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ridha Mrad
- Department of Hereditary and Congenital Diseases, Charles Nicolle Hospital
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Tahar Gargah
- Department of Pediatric Nephrology, Charles Nicolle Hospital
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Asma Omezzine
- Department of Biochemistry, Sahloul Hospital, Tunisia
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