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Zhu R, Zhu M, Wang B, Chen E, Cai D, Yang Y, Liang Y, Su C, Wang D, Sun X, Huang L, Xie Y. Prenatal diagnosis of dent disease type I with a nonsense pathogenic variant in CLCN5: a case study. BMC Med Genomics 2024; 17:34. [PMID: 38267993 PMCID: PMC10809533 DOI: 10.1186/s12920-024-01809-7] [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: 08/09/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Dent disease type I is a rare X-linked recessive renal tubular disease resulting from pathogenic variants in the CLCN5 gene. Due to the rarity of Dent disease type I and the diversity of its phenotypes, its clinical diagnosis is complex and poses a challenge to clinicians. METHODS A foetus and a child from a 36-year-old pregnant woman with a birth history of abnormal children were enrolled in this study. Pregnant women undergo amniocentesis for prenatal diagnosis at the gestational age of 12+ 3 weeks. Chromosomal microarray (CMA) analysis and whole-exome sequencing (WES) were employed to investigate the chromosomal copy number and single gene variants. Literature retrieval and data analysis were performed for genotype and phenotype collection analysis. RESULTS No chromosomal abnormalities or CNVs were detected in the entire family through karyotype and familial CMA analyses. WES identified a nonsense pathogenic variant in CLCN5 of the X chromosome, c.1942 C > T (exon 11, NM_000084), which was inherited from his mother, who exhibited regular clinical features. CONCLUSION This study suggests that children with low-molecular-weight proteinuria and hypercalciuria should undergo prompt genetic testing to exclude Dent disease.
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Affiliation(s)
- Ruijue Zhu
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Mingming Zhu
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Boye Wang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Enen Chen
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, The NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, 511436, Guangzhou, Guangdong, China
| | - Danlei Cai
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 510100, Guangzhou, Guangdong, China
| | - Yinghong Yang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Yi Liang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Chuqi Su
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Ding Wang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Xiaofang Sun
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China
| | - Linhuan Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhong Shan Er Road, 510100 510080, Guangzhou, Guangdong, China.
| | - Yingjun Xie
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 of Duobao Road, 510150, Guangzhou, China.
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Drosataki E, Maragkou S, Dermitzaki K, Stavrakaki I, Lygerou D, Latsoudis H, Pleros C, Petrakis I, Zaganas I, Stylianou K. Dent-2 disease with a Bartter-like phenotype caused by the Asp631Glu mutation in the OCRL gene. BMC Nephrol 2022; 23:182. [PMID: 35549682 PMCID: PMC9097321 DOI: 10.1186/s12882-022-02812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dent disease is an X-linked disorder characterized by low molecular weight proteinuria (LMWP), hypercalciuria, nephrolithiasis and chronic kidney disease (CKD). It is caused by mutations in the chloride voltage-gated channel 5 (CLCN5) gene (Dent disease-1), or in the OCRL gene (Dent disease-2). It is associated with chronic metabolic acidosis; however metabolic alkalosis has rarely been reported. CASE PRESENTATION We present a family with Dent-2 disease and a Bartter-like phenotype. The main clinical problems observed in the proband included a) primary phosphaturia leading to osteomalacia and stunted growth; b) elevated serum calcitriol levels, leading to hypercalcemia, hypercalciuria, nephrolithiasis and nephrocalcinosis; c) severe salt wasting causing hypotension, hyperaldosteronism, hypokalemia and metabolic alkalosis; d) partial nephrogenic diabetes insipidus attributed to hypercalcemia, hypokalemia and nephrocalcinosis; e) albuminuria, LMWP. Phosphorous repletion resulted in abrupt cessation of hypercalciuria and significant improvement of hypophosphatemia, physical stamina and bone histology. Years later, he presented progressive CKD with nephrotic range proteinuria attributed to focal segmental glomerulosclerosis (FSGS). Targeted genetic analysis for several phosphaturic diseases was unsuccessful. Whole Exome Sequencing (WES) revealed a c.1893C > A variant (Asp631Glu) in the OCRL gene which was co-segregated with the disease in male family members. CONCLUSIONS We present the clinical characteristics of the Asp631Glu mutation in the OCRL gene, presenting as Dent-2 disease with Bartter-like features. Phosphorous repletion resulted in significant improvement of all clinical features except for progressive CKD. Angiotensin blockade improved proteinuria and stabilized kidney function for several years.
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Affiliation(s)
- Eleni Drosataki
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece
| | - Sevasti Maragkou
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece
| | - Kleio Dermitzaki
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece
| | - Ioanna Stavrakaki
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece
| | - Dimitra Lygerou
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece
| | - Helen Latsoudis
- Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Christos Pleros
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece
| | - Ioannis Petrakis
- Department of Nephrology, Saarland University Medical Center, Homburg, Germany
| | - Ioannis Zaganas
- Neurogenetics Laboratory Medical School, University of Crete, Heraklion, Greece
| | - Kostas Stylianou
- Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece.
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Soares RB, Bhat N. Dent Disease Type 1: A Diagnostic Dilemma and Review. Cureus 2022; 14:e23910. [PMID: 35530822 PMCID: PMC9076049 DOI: 10.7759/cureus.23910] [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] [Accepted: 04/07/2022] [Indexed: 11/08/2022] Open
Abstract
This case report describes a boy with a rare genetic disease that primarily affects the kidneys and has implications on growth and development. Dent disease type 1 is an X-linked tubulopathy mainly caused by inactivating mutations in the chloride voltage-gated channel 5 (CLCN5) gene. It is a rare but important diagnosis for children with variable phenotypic presentations that can include low molecular weight proteinuria (LMWP), nephrocalcinosis, bony deformities and possible progression to early-onset renal failure. A delay in diagnosis is often encountered when it comes to Dent disease. This is due to the similarities in presentation of the disease to other commonly seen pediatric conditions (such as minimal change nephrotic syndrome, nutritional rickets, renal tubular acidosis [RTA], etc.) and also since it can present with variable phenotypes and has a great amount of allelic heterogeneity. In this case, it was diagnosed after 13 years from symptom onset. The patient was subjected to alternative forms of medicine, multiple working diagnoses and associated treatments at various hospitals which most likely contributed to a faster disease progression. In addition to the treatment of the disease, growth hormone (GH) therapy has proven to be beneficial but was not offered to this patient. In this case, we would also like to report some rare findings such as persistent hypercholesterolemia and steroid-resistant nephrotic syndrome (SRNS) biopsy pattern. We decided to pursue this particular disease to highlight the importance of having a high clinical suspicion with a view to attain a definitive diagnosis and instituting appropriate treatment as soon as possible. We also highlight the importance of keeping the patient informed about their disease, the possible therapeutic options and the importance of genetic counselling and patient education.
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Jin YY, Huang LM, Quan XF, Mao JH. Dent disease: classification, heterogeneity and diagnosis. World J Pediatr 2021; 17:52-57. [PMID: 32248351 DOI: 10.1007/s12519-020-00357-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dent disease is a rare tubulopathy characterized by manifestations of proximal tubular dysfunction, which occurs almost exclusively in males. It mainly presents symptoms in early childhood and may progress to end-stage renal failure between the 3rd and 5th decades of human life. According to its various genetic basis and to clinical signs and symptoms, researchers define two forms of Dent disease (Dent diseases 1 and 2) and suggest that these forms are produced by mutations in the CLCN5 and OCRL genes, respectively. Dent diseases 1 and 2 account for 60% and 15% of all Dent disease cases, and their genetic cause is generally understood. However, the genetic cause of the remaining 25% of Dent disease cases remains unidentified. DATA SOURCES All relevant peer-reviewed original articles published thus far have been screened out from PubMed and have been referenced. RESULTS Genetic testing has been used greatly to identify mutation types of CLCN5 and OCRL gene, and next-generation sequencing also has been used to identify an increasing number of unknown genotypes. Gene therapy may bring new hope to the treatment of Dent disease. The abuse of hormones and immunosuppressive agents for the treatment of Dent disease should be avoided to prevent unnecessary harm to children. CONCLUSIONS The current research progress in classification, genetic heterogeneity, diagnosis, and treatment of Dent disease reviewed in this paper enables doctors and researchers to better understand Dent disease and provides a basis for improved prevention and treatment.
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Affiliation(s)
- Yan-Yan Jin
- Department of Nephrology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, #57 Zhugan Lane, Hangzhou, 310006, China
| | - Li-Min Huang
- Department of Nephrology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, #57 Zhugan Lane, Hangzhou, 310006, China
| | - Xiao-Fang Quan
- Chigene (Beijing) Translational Medical Research Center Co. Ltd, E2 Biomedical Park, No. 88 Kechuang Sixth Ave, Yizhuang, Beijing, China
| | - Jian-Hua Mao
- Department of Nephrology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, #57 Zhugan Lane, Hangzhou, 310006, China.
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Sakakibara N, Nagano C, Ishiko S, Horinouchi T, Yamamura T, Minamikawa S, Shima Y, Nakanishi K, Ishimori S, Morisada N, Iijima K, Nozu K. Comparison of clinical and genetic characteristics between Dent disease 1 and Dent disease 2. Pediatr Nephrol 2020; 35:2319-2326. [PMID: 32683654 DOI: 10.1007/s00467-020-04701-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dent disease is associated with low molecular weight proteinuria and hypercalciuria and caused by pathogenic variants in either of two genes: CLCN5 (Dent disease 1) and OCRL (Dent disease 2). It is generally not accompanied by extrarenal manifestations and it is difficult to distinguish Dent disease 1 from Dent disease 2 without gene testing. We retrospectively compared the characteristics of these two diseases using one of the largest cohorts to date. METHODS We performed gene testing for clinically suspected Dent disease, leading to the genetic diagnosis of 85 males: 72 with Dent disease 1 and 13 with Dent disease 2. A retrospective review of the clinical findings and laboratory data obtained from questionnaires submitted in association with the gene testing was conducted for these cases. RESULTS The following variables had significantly higher levels in Dent disease 2 than in Dent disease 1: height standard deviation score (height SDS), serum creatinine-based estimated GFR (Cr-eGFR) (median: 84 vs. 127 mL/min/1.73 m2, p < 0.01), serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), serum lactate dehydrogenase (LDH), serum creatine phosphokinase (CK), serum potassium, serum inorganic phosphorus, serum uric acid, urine protein/creatinine ratio (median: 3.5 vs. 1.6 mg/mg, p < 0.01), and urine calcium/creatinine ratio. There were no significant differences in serum sodium, serum calcium, alkaline phosphatase (ALP), urine β2-microglobulin, incidence of nephrocalcinosis, and prevalence of intellectual disability or autism spectrum disorder. CONCLUSIONS The clinical and laboratory features of Dent disease 1 and Dent disease 2 were shown in this study. Notably, patients with Dent disease 2 showed kidney dysfunction at a younger age, which should provide a clue for the differential diagnosis of these diseases.
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Affiliation(s)
- Nana Sakakibara
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Ishiko
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomohiko Yamamura
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shogo Minamikawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Koichi Nakanishi
- Department of Pediatrics, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shingo Ishimori
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoya Morisada
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Clinical Genetics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Gianesello L, Del Prete D, Anglani F, Calò LA. Genetics and phenotypic heterogeneity of Dent disease: the dark side of the moon. Hum Genet 2020; 140:401-421. [PMID: 32860533 PMCID: PMC7889681 DOI: 10.1007/s00439-020-02219-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
Dent disease is a rare genetic proximal tubulopathy which is under-recognized. Its phenotypic heterogeneity has led to several different classifications of the same disorder, but it is now widely accepted that the triad of symptoms low-molecular-weight proteinuria, hypercalciuria and nephrocalcinosis/nephrolithiasis are pathognomonic of Dent disease. Although mutations on the CLCN5 and OCRL genes are known to cause Dent disease, no such mutations are found in about 25–35% of cases, making diagnosis more challenging. This review outlines current knowledge regarding Dent disease from another perspective. Starting from the history of Dent disease, and reviewing the clinical details of patients with and without a genetic characterization, we discuss the phenotypic and genetic heterogeneity that typifies this disease. We focus particularly on all those confounding clinical signs and symptoms that can lead to a misdiagnosis. We also try to shed light on a concealed aspect of Dent disease. Although it is a proximal tubulopathy, its misdiagnosis may lead to patients undergoing kidney biopsy. In fact, some individuals with Dent disease have high-grade proteinuria, with or without hematuria, as in the clinical setting of glomerulopathy, or chronic kidney disease of uncertain origin. Although glomerular damage is frequently documented in Dent disease patients’ biopsies, there is currently no reliable evidence of renal biopsy being of either diagnostic or prognostic value. We review published histopathology reports of tubular and glomerular damage in these patients, and discuss current knowledge regarding the role of CLCN5 and OCRL genes in glomerular function.
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Affiliation(s)
- Lisa Gianesello
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy
| | - Dorella Del Prete
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy
| | - Franca Anglani
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy.
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Unit, Kidney Histomorphology and Molecular Biology Laboratory, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy
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Gianesello L, Del Prete D, Ceol M, Priante G, Calò LA, Anglani F. From protein uptake to Dent disease: An overview of the CLCN5 gene. Gene 2020; 747:144662. [PMID: 32289351 DOI: 10.1016/j.gene.2020.144662] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
Proteinuria is a well-known risk factor, not only for renal disorders, but also for several other problems such as cardiovascular diseases and overall mortality. In the kidney, the chloride channel Cl-/H+ exchanger ClC-5 encoded by the CLCN5 gene is actively involved in preventing protein loss. This action becomes evident in patients suffering from the rare proximal tubulopathy Dent disease because they carry a defective ClC-5 due to CLCN5 mutations. In fact, proteinuria is the distinctive clinical sign of Dent disease, and mainly involves the loss of low-molecular-weight proteins. The identification of CLCN5 disease-causing mutations has greatly improved our understanding of ClC-5 function and of the ClC-5-related physiological processes in the kidney. This review outlines current knowledge regarding the CLCN5 gene and its protein product, providing an update on ClC-5 function in tubular and glomerular cells, and focusing on its relationship with proteinuria and Dent disease.
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Affiliation(s)
- Lisa Gianesello
- Kidney Histomorphology and Molecular Biology Laboratory, Clinical Nephrology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.
| | - Dorella Del Prete
- Kidney Histomorphology and Molecular Biology Laboratory, Clinical Nephrology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.
| | - Monica Ceol
- Kidney Histomorphology and Molecular Biology Laboratory, Clinical Nephrology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.
| | - Giovanna Priante
- Kidney Histomorphology and Molecular Biology Laboratory, Clinical Nephrology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.
| | - Lorenzo Arcangelo Calò
- Kidney Histomorphology and Molecular Biology Laboratory, Clinical Nephrology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.
| | - Franca Anglani
- Kidney Histomorphology and Molecular Biology Laboratory, Clinical Nephrology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.
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Wojciechowski D, Kovalchuk E, Yu L, Tan H, Fahlke C, Stölting G, Alekov AK. Barttin Regulates the Subcellular Localization and Posttranslational Modification of Human Cl -/H + Antiporter ClC-5. Front Physiol 2018; 9:1490. [PMID: 30405442 PMCID: PMC6206076 DOI: 10.3389/fphys.2018.01490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/02/2018] [Indexed: 01/17/2023] Open
Abstract
Dent disease 1 (DD1) is a renal salt-wasting tubulopathy associated with mutations in the Cl-/H+ antiporter ClC-5. The disease typically manifests with proteinuria, hypercalciuria, nephrocalcinosis, and nephrolithiasis but is characterized by large phenotypic variability of no clear origin. Several DD1 cases have been reported lately with additional atypical hypokalemic metabolic alkalosis and hyperaldosteronism, symptoms usually associated with another renal disease termed Bartter syndrome (BS). Expression of the Bartter-like DD1 mutant ClC-5 G261E in HEK293T cells showed that it is retained in the ER and lacks the complex glycosylation typical for ClC-5 WT. Accordingly, the mutant abolished CLC ionic transport. Such phenotype is not unusual and is often observed also in DD1 ClC-5 mutants not associated with Bartter like phenotype. We noticed, therefore, that one type of BS is associated with mutations in the protein barttin that serves as an accessory subunit regulating the function and subcellular localization of ClC-K channels. The overlapping symptomatology of DD1 and BS, together with the homology between the proteins of the CLC family, led us to investigate whether barttin might also regulate ClC-5 transport. In HEK293T cells, we found that barttin cotransfection impairs the complex glycosylation and arrests ClC-5 in the endoplasmic reticulum. As barttin and ClC-5 are both expressed in the thin and thick ascending limbs of the Henle's loop and the collecting duct, interactions between the two proteins could potentially contribute to the phenotypic variability of DD1. Pathologic barttin mutants differentially regulated trafficking and processing of ClC-5, suggesting that the interaction between the two proteins might be relevant also for the pathophysiology of BS. Our findings show that barttin regulates the subcellular localization not only of kidney ClC-K channels but also of the ClC-5 transporter, and suggest that ClC-5 might potentially play a role not only in kidney proximal tubules but also in tubular kidney segments expressing barttin. In addition, they demonstrate that the spectrum of clinical, genetic and molecular pathophysiology investigation of DD1 should be extended.
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Affiliation(s)
| | - Elena Kovalchuk
- Institute for Neurophysiology, Hannover Medical School, Hanover, Germany
| | - Lan Yu
- Institute for Neurophysiology, Hannover Medical School, Hanover, Germany
| | - Hua Tan
- Institute of Complex Systems 4 (ICS-4) – Zelluläre Biophysik, Forschungszentrum Jülich, Jülich, Germany
| | - Christoph Fahlke
- Institute of Complex Systems 4 (ICS-4) – Zelluläre Biophysik, Forschungszentrum Jülich, Jülich, Germany
| | - Gabriel Stölting
- Institute of Complex Systems 4 (ICS-4) – Zelluläre Biophysik, Forschungszentrum Jülich, Jülich, Germany
| | - Alexi K. Alekov
- Institute for Neurophysiology, Hannover Medical School, Hanover, Germany
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van Berkel Y, Ludwig M, van Wijk JAE, Bökenkamp A. Proteinuria in Dent disease: a review of the literature. Pediatr Nephrol 2017; 32:1851-1859. [PMID: 27757584 PMCID: PMC5579149 DOI: 10.1007/s00467-016-3499-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dent disease is a rare X-linked recessive proximal tubulopathy caused by mutations in CLCN5 (Dent-1) or OCRL (Dent-2). As a rule, total protein excretion (TPE) is low in tubular proteinuria compared with glomerular disease. Several authors have reported nephrotic-range proteinuria (NP) and glomerulosclerosis in Dent disease. Therefore, we aimed to analyze protein excretion in patients with documented CLCN5 or OCRL mutations in a systematic literature review. DESIGN PubMed and Embase were searched for cases with documented CLCN5 or OCRL mutations and (semi-)quantitative data on protein excretion. The most reliable data (i.e., TPE > protein-creatinine ratio > Albustix) was used for NP classification. RESULTS Data were available on 148 patients from 47 reports: 126 had a CLCN5 and 22 an OCRLmutation. TPE was not significantly different between both forms (p = 0.11). Fifty-five of 126 (43.7 %) Dent-1 vs 13/22 (59.1 %) Dent-2 patients met the definition of NP (p = 0.25). Serum albumin was normal in all reported cases (24/148). Glomerulosclerosis was noted in 20/32 kidney biopsies and was strongly related to tubulointerstitial fibrosis, but not to kidney function or proteinuria. CONCLUSION More than half of the patients with both forms of Dent disease have NP, and the presence of low molecular weight proteinuria in a patient with NP in the absence of edema and hypoalbuminemia should prompt genetic testing. Even with normal renal function, glomerulosclerosis and tubulointerstitial fibrosis are present in Dent disease. The role of proteinuria in the course of the disease needs to be examined further in longitudinal studies.
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Affiliation(s)
- Youri van Berkel
- Department of Pediatric Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Joanna A E van Wijk
- Department of Pediatric Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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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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11
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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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12
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Platt C, Jadresic L, Dudley J, Hartley JL. Dent's disease complicated by an acute Budd-Chiari syndrome. BMJ Case Rep 2014; 2014:bcr-2013-200937. [PMID: 24398869 DOI: 10.1136/bcr-2013-200937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a young boy with Dent's disease, identified as having a mutation in the kidney-specific chloride-proton antitransporter CLCN5 during investigation for nephrotic-range proteinuria. He went on to develop growth hormone deficiency and was treated with recombinant growth hormone. He later presented acutely with hepatorenal failure and thrombotic occlusion of the middle and right hepatic veins consistent with a diagnosis of Budd-Chiari syndrome, which required a prolonged period of intensive care. The diagnosis of Dent's disease should be considered early in boys with nephrotic-range proteinuria in the absence of clinical oedema and hypoalbuminaemia to allow for the timely introduction of strategies, such as a high-citrate diet, to preserve renal function. The measurement of urinary β-2 microglobulin has been shown by this case to be a more reliable and specific marker of tubular dysfunction than the urinary retinol-binding protein.
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Affiliation(s)
- Caroline Platt
- Department of Paediatrics, Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, UK
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13
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An atypical Dent's disease phenotype caused by co-inheritance of mutations at CLCN5 and OCRL genes. Eur J Hum Genet 2012; 21:687-90. [PMID: 23047739 DOI: 10.1038/ejhg.2012.225] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Dent's disease is an X-linked renal tubulopathy caused by mutations mainly affecting the CLCN5 gene. Defects in the OCRL gene, which is usually mutated in patients with Lowe syndrome, have been shown to lead to a Dent-like phenotype called Dent disease 2. However, about 20% of patients with Dent's disease carry no CLCN5/OCRL mutations. The disease's genetic heterogeneity is accompanied by interfamilial and intrafamilial phenotypic heterogeneity. We report on a case of Dent's disease with a very unusual phenotype (dysmorphic features, ocular abnormalities, growth delay, rickets, mild mental retardation) in which a digenic inheritance was discovered. Two different, novel disease-causing mutations were detected, both inherited from the patient's healthy mother, that is a truncating mutation in the CLCN5 gene (A249fs*20) and a donor splice-site alteration in the OCRL gene (c.388+3A>G). The mRNA analysis of the patient's leukocytes revealed an aberrantly spliced OCRL mRNA caused by in-frame exon 6 skipping, leading to a shorter protein, but keeping intact the central inositol 5-phosphatase domain and the C-terminal side of the ASH-RhoGAP domain. Only wild-type mRNA was observed in the mother's leukocytes due to a completely skewed X inactivation. Our results are the first to reveal the effect of an epistatic second modifier in Dent's disease too, which can modulate its expressivity. We surmise that the severe Dent disease 2 phenotype of our patient might be due to an addictive interaction of the mutations at two different genes.
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14
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A patient with Dent disease and features of Bartter syndrome caused by a novel mutation of CLCN5. Eur J Pediatr 2012; 171:401-4. [PMID: 21932010 DOI: 10.1007/s00431-011-1578-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/07/2011] [Indexed: 12/20/2022]
Abstract
UNLABELLED Dent disease is an X-linked tubulopathy mainly caused by inactivating mutations of CLCN5. Features of Bartter syndrome such as hypokalemic metabolic alkalosis are rarely observed in patients with Dent disease. We report a Japanese male patient with Dent disease who also manifested features of Bartter syndrome. At the age of 3 years, he was diagnosed with Dent disease based on low molecular weight proteinuria and hypercalciuria. One year later, he was found to have features of Bartter syndrome, i.e., hypokalemia and metabolic alkalosis, and high levels of plasma renin activity and aldosterone with a normal blood pressure. Despite medical interventions, he developed chronic kidney disease stage 3 at the age of 21 years. To investigate the molecular basis of his disease, CLCN5, KCNJ1, SLC12A1, and CLCkb were analyzed and a novel mutation (Y567X) in CLCN5 was identified. CONCLUSION Hypokalemic metabolic alkalosis is a rare manifestation in Dent disease. It is speculated that Dent patients with features of Bartter syndrome are susceptible to progression to renal failure. To study this hypothesis, additional observations and long-term follow-up of such patients are necessary.
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15
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Samardzic M, Pavicevic S, Ludwig M, Bogdanovic R. Effect of growth hormone replacement therapy in a boy with Dent's disease: a case report. J Med Case Rep 2011; 5:400. [PMID: 21859490 PMCID: PMC3177920 DOI: 10.1186/1752-1947-5-400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 08/22/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Dent's disease is an X-linked recessive proximal tubulopathy characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis, nephrolithiasis and progressive renal failure. To the best of our knowledge, this is only the third report on the use of growth hormone therapy in a child with poor growth associated with Dent's disease. CASE PRESENTATION We report on a 7-year-old Montenegrin boy with proteinuria, hypercalciuria, nephrocalcinosis, rickets and short stature with unimpaired growth hormone secretion. A molecular genetic analysis showed S244L substitution on the CLCN5 gene. After two years of conventional treatment with hydrochlorothiazide, laboratory tests revealed more prominent proteinuria, mild hypophosphatemia, increased values of alkaline phosphatase and features of rickets. Phosphate salts, calcitriol, potassium citrate and growth hormone were included in the therapy. After three years of therapy, his adjusted parental stature was 1.53 standard deviations higher than at the initiation of growth hormone therapy. His global kidney functions and levels of proteinuria and calciuria remained relatively stable. In spite of the growth hormone therapy, his tubular reabsorption of phosphate deteriorated. CONCLUSION Treatment with recombinant human growth hormone may have a positive effect on final height in poorly growing children with Dent's disease and hypophosphatemic rickets. However, it is not possible to reach definite conclusions due to the small sample within the literature and the brief duration of the therapy.
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Affiliation(s)
- Mira Samardzic
- Institute for Sick Children, Department of Endocrinology and Nephrology, Ljubljanska bb, 20 000 Podgorica, Montenegro
| | - Snezana Pavicevic
- Institute for Sick Children, Department of Endocrinology and Nephrology, Ljubljanska bb, 20 000 Podgorica, Montenegro
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Radovan Bogdanovic
- Institute for Mother and Child Health Care of Serbia, Department of Nephrology, Radoja Dakica 10, 11 000 Belgrade, Serbia
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16
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Bogdanović R, Draaken M, Toromanović A, Dordević M, Stajić N, Ludwig M. A novel CLCN5 mutation in a boy with Bartter-like syndrome and partial growth hormone deficiency. Pediatr Nephrol 2010; 25:2363-8. [PMID: 20680351 DOI: 10.1007/s00467-010-1615-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
Abstract
Dent disease is an X-linked recessive disorder affecting the proximal tubule and is characterized by low-molecular-weight proteinuria (LMWP), hypercalciuria, nephrocalcinosis/nephrolithiasis with a variable number of features of Fanconi syndrome. It is most often associated with mutations in CLCN5, which encodes the endosomal electrogenic chloride/proton exchanger ClC-5. Renal acidification abnormalities are only rarely seen in Dent disease, whereas the hypokalemic metabolic alkalosis associated with hyperreninemic hyperaldosteronism (Bartter-like syndrome) has been reported in only one patient so far. We report on a 5-year-old boy with Dent disease caused by mutation in CLCN5 gene, c.1073G>A, who presented with hypokalemic metabolic alkalosis and hyperreninemic hyperaldosteronism persisting over the entire follow-up. No mutations were found in NKCC2, ROMK, NCCT, or ClC-Kb genes. In addition, the patient exhibited growth failure associated with partial growth hormone (GH) deficiency. Coexistence of Bartter-like syndrome features with LMWP should prompt a clinician to search for Dent disease. The Bartter syndrome phenotype seen in Dent disease patients may represent a distinct form of Bartter syndrome, the exact mechanism of which has yet to be fully elucidated. Growth delay that persists in spite of appropriate therapy should raise suspicion of other causes, such as GH deficiency.
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Affiliation(s)
- Radovan Bogdanović
- The Institute of Mother and Child Healthcare of Serbia Dr Vukan Cupić, 8 Radoja Dakica Street, 11070, Belgrade, Serbia.
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Hou JW. Amelioration of hypophosphatemic rickets and osteoporosis with pamidronate and growth hormone in Lowe syndrome. J Formos Med Assoc 2010; 108:730-5. [PMID: 19773212 DOI: 10.1016/s0929-6646(09)60397-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The oculocerebrorenal syndrome of Lowe, an X-linked multisystem disorder, was diagnosed in a male patient who presented with typical abnormalities of the eyes, kidneys and nervous system. Besides congenital cataracts, renal tubular dysfunction and psychomotor retardation, the patient had also suffered from profound failure to thrive, growth hormone deficiency, severe osteoporosis with hypophosphatemic rickets, and progressive renal dysfunction since early childhood, which were attributed to the metabolic derangements following Fanconi syndrome. Direct sequencing of the OCRL1 gene (responsible for the oculocerebrorenal syndrome of Lowe) revealed a de novo c.2282_2283insT in exon 20, which resulted in premature termination of translation (D762X). After monthly intravenous administration of pamidronate since the age of 17.8 years, his urine creatinine clearance and tubular resorption of phosphate increased slightly and bone mineral density was much improved (Z score increased from -7.3 to -3.3) without deterioration of renal function. Simultaneous growth hormone therapy enhanced the positive response. The beneficial osseous and renal effects of the bisphosphonate, along with growth hormone treatment in Lowe syndrome with hypophosphatemia, may be related to reduced renal calcium and phosphate excretion.
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Affiliation(s)
- Jia-Woei Hou
- Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, Taiwan.
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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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