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Bai P, Zhang W, Lai L, Huang H, Qin J, Duan B, Wang H, Chen Y, Jia Y, Xing J, Wang T, Chen B. Declaration: Novel SLC3A1 mutation in a cystinuria patient with xanthine stones: a case report. BMC Urol 2023; 23:130. [PMID: 37525149 PMCID: PMC10391995 DOI: 10.1186/s12894-023-01300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Cystinuria and xanthinuria are both rare genetic diseases involving urinary calculi. However, cases combining these two disorders have not yet been reported. CASE PRESENTATION In this study, we report a case of cystinuria with xanthine stones and hyperuricemia. The 23-year-old male patient was diagnosed with kidney and ureteral stones, solitary functioning kidney and hyperuricemia after admission to the hospital. The stones were removed by surgery and found to be composed of xanthine. CONCLUSION Genetic testing by next-generation sequencing technology showed that the patient carried the homozygous nonsense mutation c.1113 C> A (p.Tyr371*) in the SLC3A1 gene, which was judged to be a functionally pathogenic variant. Sanger sequencing revealed that the patient's parents carried this heterozygous mutation, which is a pathogenic variant that can cause cystinuria. The 24-h urine metabolism analysis showed that the cystine content was 644 mg (<320 mg/24 h), indicating that the patient had cystinuria, consistent with the genetic test results. This case shows that cystinuria and xanthine stones can occur simultaneously, and provides evidence of a possible connection between the two conditions. Furthermore, our findings demonstrate the potential value of genetic testing using next-generation sequencing to effectively assist in the clinical diagnosis and treatment of patients with urinary calculi.
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Affiliation(s)
- Peide Bai
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - WenZhao Zhang
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Longhui Lai
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Haichao Huang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jiaxuan Qin
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Bo Duan
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huiqiang Wang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yuedong Chen
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yuanyuan Jia
- GloriousMed Clinical Laboratory (Shanghai) Co., Ltd, Shanghai, China
| | - Jinchun Xing
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Tao Wang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.
| | - Bin Chen
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Knoll T, Zöllner A, Wendt-Nordahl G, Michel MS, Alken P. Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up. Pediatr Nephrol 2005; 20:19-24. [PMID: 15602663 DOI: 10.1007/s00467-004-1663-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 08/09/2004] [Accepted: 08/17/2004] [Indexed: 10/26/2022]
Abstract
Cystinuria, an autosomal-recessive disorder of a renal tubular amino acid transporter, is the cause of about 10% of all kidney stones observed in children. Different genetic characteristics are not represented by different phenotypes. The stones are formed of cystine, which is relatively insoluble at the physiological pH of urine. Without any preventive measures, the patients will suffer from recurrent stone formation throughout their life. Even with medical management, long-term outcome is poor due to insufficient efficacy and low patient compliance. Many patients suffer from renal insufficiency as a result of recurrent stone formation and repeated interventions. However, regular follow-up and optimal pharmacotherapy significantly increase stone-free intervals. Medical management is mainly based on hyperhydration and urine alkalinization. Sulfhydryl agents such as tiopronin can be added. Recurrent stone formation necessitates repeated urological interventions. These mostly minimally invasive procedures carry the risk of impairment of renal function. In adults, extracorporeal shockwave lithotripsy (SWL) as well as intracorporeal lithotripsy is often unsuccessful. However, in children SWL shows excellent results for cystine stones. In cases with large stone burden, percutaneous nephrolithotripsy (PNL) or even open surgical nephrolithotomy are preferred. This review discusses the underlying pathogenetic mechanisms and provides guidance for the diagnosis, therapy, and management of cystinuria following the recommendations of the International Cystinuria Consortium and the European Association of Urology.
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Affiliation(s)
- Thomas Knoll
- Department of Urology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
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Abstract
Urinary stone disease is the only clinical presentation in patients with cystinuria. Two genes have been associated with type I (SLC3A1) and non-type I (SLC7A9) cystinuria and multiple mutations of these genes have been identified. The type I form is completely recessive while the non-type I form is incompletely recessive. Clinically, heterozygotes with type I mutations are silent while heterozygotes with non-type I (types II and III) present with a wide range of urinary cystine levels and some even have symptomatic urolithiasis. Although the exact molecular basis for these differences needs additional investigations, the future of medical management of cystinuria is based on molecular and gene therapy. Minimally invasive surgery using percutaneous and ureteroscopic techniques is the cornerstone of surgical management. Both cystine and struvite calculi can form staghorn configuration with propensity for rapid growth and frequent recurrences after surgical treatment. While urinary alkalinization for cystine calculi is an integral part of medical management, the effect of oral alkalinizing agents is limited because of the high pKa (8.3) of cystine. Chelating agents, therefore, are frequently used to decrease cystine solubility and stone recurrences. Similarly, urinary acidification for struvite calculi may dissolve existing stones and prevent recurrences. However, no effective oral agent is available today. A future challenge will be to introduce reliable oral agents for urinary acidification.
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Affiliation(s)
- Bijan Shekarriz
- Department of Urology, SUNY, Upstate Medical University, Syracuse, NY 13210, USA
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Abstract
This past year produced some remarkable reports on renal (and other urinary) calculi. Randall's plaques have returned, phosphate relates to insulin and lipid metabolism, and sialic acid is out. Risk factors for astronauts, cystinuric individuals, older and indinavir patients achieve importance. Discovery by spiral computed tomography advances, teleconsultation emerges and shot-gun therapy with potassium-magnesium citrate succeeds. Endoscopic or shock wave lithotripsy vie for which is best, and both attempt to eliminate open surgery. Yet open surgery still has its place.
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Affiliation(s)
- G W Drach
- Division of Urology, University of Pennsylvania, Philadelphia 19104, USA. drachgw-mail.med.upenn.edu
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