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Yokoe T, Tajima T, Yamaguchi N, Morita Y, Chosa E. A case of nail-patella syndrome with osteochondral lesion of the lateral femoral condyle accompanied with anomalies of anterior horns of the menisci and lateral femoral condyle. J Orthop Sci 2023; 28:1543-1547. [PMID: 34690047 DOI: 10.1016/j.jos.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Millard N. A rare disorder causing chronic joint pain in an adolescent. JAAPA 2021; 34:32-34. [PMID: 33470719 DOI: 10.1097/01.jaa.0000731500.86110.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This article describes a patient with chronic knee pain and deformities of her hands and feet that led to a diagnosis of nail-patella syndrome, a rare autosomal dominant disorder.
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Affiliation(s)
- Nicole Millard
- Nicole Millard practices in family medicine at Wake Forest Baptist Health in Mount Airy, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise
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Abstract
CASE A 46-year-old woman with a medical history of nail-patella syndrome (NPS) presented with chronic right knee pain. Radiographic and physical examination revealed isolated medial tibiofemoral osteoarthritis and a hypoplastic laterally subluxed patella. The patient was successfully treated with a medial unicompartmental knee arthroplasty (UKA). CONCLUSION In patients with NPS and osteoarthritis limited to one tibiofemoral compartment, a UKA may be successfully performed.
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Affiliation(s)
- JaeWon Yang
- 1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois 2Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, California
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Nashelsky Zolotov L, Reinstein E. Schizophrenia and Nail Patella Syndrome: The Dopamine Connection. Isr Med Assoc J 2018; 20:496-498. [PMID: 30084575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nail-patella syndrome (NPS) is characterized by changes in the nails, knees, and elbows, as well as the presence of iliac horns detected by X-ray of the pelvis. A higher occurrence of psychiatric disorders has also been suggested in NPS. Heterozygous mutations in the gene encoding the LIM-homeodomain transcription factor (LMX1B) are identified in most patients with typical clinical findings of NPS. OBJECTIVES To report on the association between NPS and schizophrenia. METHODS Genomic DNA were isolated from a patient's venous blood and collected on ethylenediaminetetraacetic 5% with the Gentra Puregene Blood Kit. All exons and flanking regions of the LMX1B gene (LMX1B: NM_001174146.1) were amplified by standard polymerase chain reaction and analyzed by direct DNA sequencing with BigDye Terminators on an ABI 3100 sequencer. Sequence chromatograms were analyzed using SeqScape software version 1.1. Mutation analysis and characterization of variants was performed with the Alamut Software Version 2.1. RESULTS We report a patient presenting to the psychiatry department with schizophrenia. Clinical examination revealed characteristic findings consistent with NPS. Since NPS was suspected, based on clinical findings, sequencing of all coding exons of LMX1B gene was completed. Results revealed a novel heterozygous mutation in the proband: c.546_547insACCG(het); p.Glu183Thrfs*11. CONCLUSIONS Based on LMX1B expression in brain regions that are implicated in neuropsychiatric illness, and especially in the development of dopaminergic neurons, we hypothesize that schizophrenia may be part of the clinical spectrum of NPS.
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Affiliation(s)
| | - Eyal Reinstein
- Institute of Medical Genetics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Senguttuvan NB, Sivaraman A, Kandasamy D, Marimuthu K. Nail patella syndrome: a rare cause of renal failure in a young adult. Pan Afr Med J 2011; 9:31. [PMID: 22145064 PMCID: PMC3215553 DOI: 10.4314/pamj.v9i1.71207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 07/21/2011] [Indexed: 11/17/2022] Open
Abstract
Nail Patella Syndrome (NPS) is a rare hereditary disease affecting multiple systems with predominant involvement of Kidney, Bones and Nails and Eyes. We report a case of NPS which presented as renal failure in a 22 year old male. The patient was admitted with decreased urine output and features of fluid overload and was being evaluated for renal failure. Physical examination revealed associated bony deformities which raised the suspicion of NPS as a possible etiology. This was confirmed by the radiological evaluation which showed the classical features of NPS. Though NPS is a rare clinical condition, physicians should complete knowledge about the components of NPS for appropriate diagnosis and for early detection of other systems involvement.
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Abstract
Nail-patella syndrome is an autosomal-dominant hereditary disease named for dysplastic fingernails and toenails and hypoplastic or absent kneecaps evident in patients with the syndrome. Prognosis is determined by the nephropathy that develops in many such patients. Besides podocyte foot-process effacement, pathognomonic changes in the kidney comprise electron-lucent areas and fibrillar inclusions in the glomerular basement membrane. These characteristic symptoms are caused by mutations in the gene encoding the transcription factor LMX1B, a member of the LIM-homeodomain gene family. Comparable with the human syndrome, homozygous Lmx1b knockout mice lack patellae and suffer from severe podocyte damage. In contrast, however, podocin and the alpha3 and alpha4 chains of collagen IV are absent in the glomeruli of Lmx1b knockout mice. Further studies with podocyte-specific Lmx1b knockout mice have confirmed the importance of LMX1B in podocytes, as these mice apparently develop foot processes initially but lose them later on. We therefore conclude that LMX1B is essential for the development of metanephric precursor cells into podocytes and possibly also for maintaining the differentiation status of podocytes. LMX1B can serve as a model system to elucidate a genetic program in podocytes.
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Affiliation(s)
- Ralph Witzgall
- University of Regensburg, Institute for Molecular and Cellular Anatomy, Universitätsstrasse 31, 93053 Regensburg, Germany
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8
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Steens SC, Kroon HM, Taminiau AH, De Schepper AM, Watt I. Nail-patella syndrome associated with Ewing sarcoma. JBR-BTR 2007; 90:214-5. [PMID: 17696103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- S C Steens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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9
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Granata A, Gianrenato N. Quiz page. Nail-patella syndrome. Am J Kidney Dis 2006; 48:e25-6, A34. [PMID: 16933400 DOI: 10.1053/j.ajkd.2006.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Granata
- Department of Nephrology and Dialysis, Catania and Terni, Italy
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Hari P, Mantan M, Dinda A, Hari S, Bagga A. Steroid-responsive nephrotic syndrome in a patient with nail-patella syndrome. Pediatr Nephrol 2006; 21:1197-9. [PMID: 16807765 DOI: 10.1007/s00467-006-0154-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 12/16/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
Nail-patella syndrome (NPS) is a rare disorder with autosomal dominant mode of inheritance. We report a child with NPS and steroid-responsive, frequently relapsing nephrotic syndrome. The child had dystrophic nails, flexion contractures of both elbows and normal renal functions. X-rays of the knees and pelvis showed hypoplastic patellae and iliac horns. Renal histology was unremarkable with mild focal increase in mesangial cellularity compatible with minimal change disease. Ultrastructural features of NPS including thickening of the glomerular basement membrane with electron-lucent areas were not found.
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Affiliation(s)
- Pankaj Hari
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Abstract
Nail patella syndrome (NPS) is a rare autosomal dominant disorder resulting from a heterogeneous loss of function in the LMX1B gene. It is associated with multiple skeletal deformities, yet it is unknown whether this is associated with osteoporosis. To examine bone mass and the prevalence of fragility fractures, we assessed bone mineral density (BMD) of the spine and hip in 31 adults and 12 children with mutation-confirmed NPS and 60 healthy age- and gender-matched adult controls. For the adults with NPS, BMD was 11-20% lower at the hip sites (P < or = 0.001) and 8% lower at the spine (P < 0.05) than that of controls. Even when adjusted for body mass index, the BMD remained significantly lower in patients with NPS in all hip regions but not in the spine. Adults with NPS also had a significantly lower Z-score (sd values from normal) at all hip sites (all P < 0.05), compared with age- and gender-matched controls in the manufacturer's database. However, children had significantly lower Z-scores only at the femoral neck and trochanter. Participants with NPS also had a higher prevalence of fractures (odds ratio 30.9, 95% confidence interval 6.4-149.6, P < 0.001) and scoliosis (odds ratio 16.0, 95% confidence interval 3.3-78.2, P < 0.001). The majority of these fractures occurred in women before puberty and in long bones, especially the clavicle. We conclude that adults with NPS have a BMD that is 8-20% lower than controls, which is associated with an increase in the prevalence of fractures and scoliosis. Future studies are needed to determine whether bone quality, geometry, or turnover could account for these findings.
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Affiliation(s)
- Adele L Towers
- University of Pittsburgh, Osteoporosis Prevention and Treatment Center, Kaufmann Medical Building, Suite 1110, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213-3221, USA
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Zuppan CW, Weeks DA, Cutler D. Nail-patella glomerulopathy without associated constitutional abnormalities. Ultrastruct Pathol 2003; 27:357-61. [PMID: 14708727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
A 17-year-old boy presented with a history of longstanding hematuria and non-nephrotic proteinuria without renal insufficiency, for which renal biopsy was performed. The findings by routine light microscopy and direct immunofluorescence study were mild and nonspecific. Electron microscopy, however, demonstrated the unexpected finding of distinct collagen fibrils within capillary wall basement membranes, typical of the nail-patella syndrome. Repeat physical examination following the biopsy confirmed the presence of normal nails and patellae, and radiographs of the knees were also normal. The boy's renal disease was stable at last follow-up. The authors briefly discuss the differential diagnosis, and suggest that this case represents an unusual manifestation of the nail-patella syndrome, in which the glomerular changes are present in the absence of the usual associated constitutional abnormalities.
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Affiliation(s)
- Craig W Zuppan
- Department of Pathology, Loma Linda University and Medical Center, Loma Linda, California 92354, USA.
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Affiliation(s)
- Josef Finsterer
- Neurological Hospital Rosenhügel, KA Rudolfstiftung, Vienna, Austria.
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Affiliation(s)
- David J Jacofsky
- Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA
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Abstract
The long-term skeletal changes and the lack of significant clinical complaints in a 77-year-old woman with nail patella syndrome are described. Fifty-five years previously she was one of the first reported patients. These early patients came from two families with involvement of multiple individuals with the variable constellation of deformities. We reviewed her skeletal natural history and her family history as it related to nail patella syndrome involvement and treatment, and correlated the original premolecular biology description and subsequent long-term follow-up with the current molecular and genetic concepts of the cause of the variable expression of nail patella syndrome.
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Affiliation(s)
- John A Ogden
- Skeletal Educational Association, Atlanta, Georgia 30305, USA
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Bongers EMHF, Gubler MC, Knoers NVAM. Nail-patella syndrome. Overview on clinical and molecular findings. Pediatr Nephrol 2002; 17:703-12. [PMID: 12215822 DOI: 10.1007/s00467-002-0911-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2001] [Revised: 03/12/2002] [Accepted: 04/11/2002] [Indexed: 11/26/2022]
Abstract
Nail-patella syndrome (NPS) is a rare autosomal dominant pleiotropic disorder characterized by dysplasia of the nails, patellar aplasia or hypoplasia, iliac horns, dysplasia of the elbows, and frequently glaucoma and progressive nephropathy. The recent identification of the causative gene for this syndrome has initiated further studies of the phenotype and molecular pathogenesis of kidney disease in NPS. The gene underlying NPS, LMX1B, is a LIM-homeodomain transcription factor involved in normal patterning of the dorsoventral axis of the limb during development and early morphogenesis of the glomerular basement membrane. Molecular studies of Lmx1b, combined with genetic and immunohistochemical investigation of different alpha chains of type IV collagen in the Lmx1b null mice kidney, a mouse model for NPS, have provided evidence that Lmx1b is involved in the pathogenesis of NPS glomerulopathy. At present evidence for a correlation between the presence and severity of the renal and extrarenal anomalies and LMX1B genotype is lacking. This review focuses on the recent advances in clinical and molecular genetic studies of NPS.
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Affiliation(s)
- Ernie M H F Bongers
- Department of Human Genetics, University Medical Centre Nijmegen, Netherlands
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Lee JJ, Chiu YW, Kuo YT, Chen HC, Hwang SJ. Nail-patella syndrome with renal involvement and antecubital pterygia. J Formos Med Assoc 2002; 101:655-60. [PMID: 12645195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Nail-patella syndrome (NPS) is a rare, autosomal-dominant hereditary disorder characterized by nail dysplasia and multiple osseous abnormalities. Some patients may develop renal function impairment and even end-stage renal disease. We treated a 42-year-old female patient with proteinuria who presented with a web-like structure over the antecubital fossa and hypoplastic patellae. In addition, she had other characteristic findings, including bilateral iliac horn, triangular nail lunulae and hypoplastic radial head. She had impaired renal function, and renal biopsy showed mesangial proliferative glomerulonephritis. Additional cases were found in her family. Her mother had most of the signs of NPS as well as advanced renal failure. Her elder sister had knee abnormalities without the web-like elbow condition. Both daughters also had the characteristic features of NPS. During follow-up 30 months after the initial examination, the patient had stable renal function and mild proteinuria.
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Affiliation(s)
- Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chua HL, Tan LK, Tan HK, Tan ASA, Choong HL. The course of pregnancy in a patient with nail-patella syndrome. Ann Acad Med Singap 2002; 31:349-52. [PMID: 12061296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The nail-patella syndrome is a rare autosomal dominant condition with high penetrance. Pregnancy in such a patient is rare and we believe this to be the first report of a live birth occurring in a patient with nail-patella syndrome. CLINICAL PICTURE A 25-year-old patient presented in her first pregnancy with nephrotic syndrome associated with characteristic bone abnormalities and nail dysplasia and was later diagnosed to have nail-patella syndrome. In her second pregnancy, the course of her pregnancy was complicated by further deterioration of renal function with superimposed pre-eclampsia resulting in early delivery at 28 weeks. CONCLUSION Such pregnancies should be regarded as high risk and managed jointly with the renal physician in a tertiary care centre to ensure an optimal outcome to the mother and baby.
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Affiliation(s)
- H L Chua
- Department of Obstetrics and Gynaecology, Singapore General Hospital, 1 Hospital Drive, Singapore 169608
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Abstract
Buschke-Ollendorf syndrome and nail-patella syndrome are both rare connective tissue disorders inherited in an autosomal dominant pattern and characterized by cutaneous and bone lesions. We describe a 3-year-old boy and his family who showed clinical features of both Buschke-Ollendorf syndrome and nail-patella syndrome. To our knowledge, this association has not been reported previously, suggesting that these two connective tissue disorders may share the same gene location with different mutations or involve different mutated genes that share downstream segments of their signaling pathways. Furthermore, this young patient is also affected by a chronic idiopathic neutropenia usually not observed in Buschke-Ollendorf syndrome or nail-patella syndrome.
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Affiliation(s)
- Christian Allen Drouin
- Centre hospitalier du Grand-Portage, 75 rue St-Henri, Rivière-du-Loup, Quebec G5R 2A4, Canada
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Vanhooteghem O, Henrijean A, Richert B, De La Brassinne M. [Hereditary osteo-onychodysplasia (nail patella syndrome)]. Ann Dermatol Venereol 2001; 128:1063-7. [PMID: 11907973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- O Vanhooteghem
- Service de Dermatologie, CHU du Sart Tilman, B-4000, Liège, Belgique
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Affiliation(s)
- X Gao
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
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Morello R, Zhou G, Dreyer SD, Harvey SJ, Ninomiya Y, Thorner PS, Miner JH, Cole W, Winterpacht A, Zabel B, Oberg KC, Lee B. Regulation of glomerular basement membrane collagen expression by LMX1B contributes to renal disease in nail patella syndrome. Nat Genet 2001; 27:205-8. [PMID: 11175791 DOI: 10.1038/84853] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Basement membrane (BM) morphogenesis is critical for normal kidney function. Heterotrimeric type IV collagen, composed of different combinations of six alpha-chains (1-6), is a major matrix component of all BMs (ref. 2). Unlike in other BMs, glomerular BM (GBM) contains primarily the alpha 3(IV) and alpha 4(IV) chains, together with the alpha 5(IV) chain. A poorly understood, coordinated temporal and spatial switch in gene expression from ubiquitously expressed alpha 1(IV) and alpha 2(IV) collagen to the alpha 3(IV), alpha 4(IV) and alpha 5(IV) chains occurs during normal embryogenesis of GBM (ref. 4). Structural abnormalities of type IV collagen have been associated with diverse biological processes including defects in molecular filtration in Alport syndrome, cell differentiation in hereditary leiomyomatosis, and autoimmunity in Goodpasture syndrome; however, the transcriptional and developmental regulation of type IV collagen expression is unknown. Nail patella syndrome (NPS) is caused by mutations in LMX1B, encoding a LIM homeodomain transcription factor. Some patients have nephrosis-associated renal disease characterized by typical ultrastructural abnormalities of GBM (refs. 8,9). In Lmx1b(-/-) mice, expression of both alpha(3)IV and alpha(4)IV collagen is strongly diminished in GBM, whereas that of alpha1, alpha2 and alpha5(IV) collagen is unchanged. Moreover, LMX1B binds specifically to a putative enhancer sequence in intron 1 of both mouse and human COL4A4 and upregulates reporter constructs containing this enhancer-like sequence. These data indicate that LMX1B directly regulates the coordinated expression of alpha 3(IV) and alpha 4(IV) collagen required for normal GBM morphogenesis and that its dysregulation in GBM contributes to the renal pathology and nephrosis in NPS.
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Affiliation(s)
- R Morello
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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Jansen T, Happe M, Luther H, Altmeyer P. [Nail-patella syndrome. Possible kidney failure as a complication]. MMW Fortschr Med 2000; 142:50-1. [PMID: 11107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- T Jansen
- Klinik für Dermatologie und Allergologie, Ruhr-Universität Bochum
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Knoers NVAM, Bongers EMHF, Beersum SECVAN, Lommen EJP, Bokhoven HVAN, Hol FA. Nail-patella syndrome: identification of mutations in the LMX1B gene in Dutch families. J Am Soc Nephrol 2000; 11:1762-1766. [PMID: 10966502 DOI: 10.1681/asn.v1191762] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nail-patella syndrome is an autosomal dominant disorder characterized by dyplasia of finger nails, skeletal anomalies, and, frequently, renal disease. It has recently been shown that this disorder is caused by putative loss-of-function mutations in a transcription factor (LMX1B) belonging to the LIM-homeodomain family, members of which are known to be important for pattern formation during development. A cohort of eight Dutch NPS families were screened for mutations in the LMX1B gene; seven different mutations, including one novel variant, were identified. Three of the mutations are very likely to result in truncated LMX1B proteins, three are predicted to influence sequence-specific DNA binding, and one is presumed to prevent the formation of a stable protein by abolishing the Zn(II) binding site of the protein. Although there was a remarkable high incidence of renal disease in one of the families, the nephropathy was not seen in all affected family members and the severity of renal impairment varied significantly among the patients. This indicates that the incidence and severity of nephropathy within this family cannot be attributed to the LMX1B genotype. In addition, evidence of a correlation between other characteristics of the NPS phenotype and specific mutations has not been found.
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Affiliation(s)
- Nine V A M Knoers
- Department of Human Genetics, University Hospital Nijmegen, Nijmegen, The Netherlands
| | - Ernie M H F Bongers
- Department of Human Genetics, University Hospital Nijmegen, Nijmegen, The Netherlands
| | | | - Ed J P Lommen
- Department of Pediatrics, St. Joseph Hospital, Veldhoven, The Netherlands
| | - Hans VAN Bokhoven
- Department of Human Genetics, University Hospital Nijmegen, Nijmegen, The Netherlands
| | - Frans A Hol
- Department of Human Genetics, University Hospital Nijmegen, Nijmegen, The Netherlands
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Lane JE, Walker AN, Chandler PW, Gresen KW. Nail-patella syndrome: an incidental finding from abdominal discomfort. South Med J 1999; 92:1213-5. [PMID: 10624918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
An otherwise healthy 18-year-old woman had abdominal discomfort. Physical examination and laboratory studies were unremarkable, with the exception of nail dystrophy of the ulnar digits. An abdominal plain film revealed bilateral posterior iliac horns, pathognomonic of nail-patella syndrome. Additional radiographs showed hypoplastic patellas bilaterally. While glomerulonephritis occurs in 30% of patients with nail-patella syndrome, there was no evidence of renal involvement.
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Affiliation(s)
- J E Lane
- Department of Pathology, Mercer University School of Medicine, Macon, Ga 31207-0001, USA
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Affiliation(s)
- E F Perçin
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Cumhuriyet, Sivas, Turkey.
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Abstract
Nail-patella syndrome (NPS), also known as hereditary onycho-osteodysplasia, is an autosomal dominant pleiotropic disorder characterized by nailbed dysplasia or hypoplasia, absent or hypoplastic patellae, iliac horns and deformation or luxation of the radial head. Nephropathy is a known serious complication associated with NPS. In this report, we describe an adult Chinese woman with the clinical and radiological features of NPS who presented with the nephrotic syndrome. Renal biopsy disclosed focal segmental glomerulosclerosis on light microscopy, while immunofluorescence revealed predominant staining for IgA in the glomerular mesangium and along some capillary walls. Ultrastructural study confirmed the presence of paramesangial deposits as well as subendothelial collagen fibrils in the glomeruli. The histological findings were those of combined NPS and IgA disease, an association which has rarely been described.
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Affiliation(s)
- K L Chuah
- Department of Pathology, Singapore General Hospital, Singapore
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Jones CH. The orthopaedic-nephrology interface. Nephrol Dial Transplant 1998; 13:2685-6. [PMID: 9794591 DOI: 10.1093/ndt/13.10.2685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C H Jones
- Department of Renal Medicine, St James's University Hospital, Leeds, UK
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30
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Abstract
Antecubital pterygium is rare in the nail-patella syndrome but common in the multiple pterygium syndrome and aplasia of the trochlea. It is known that there is the rebound phenomenon after treatment of congenital joint contracture. We describe the poor functional results due to rapid recurrence of the flexion contracture treated with the Ilizarov method for an antecubital pterygium in the nail-patella syndrome.
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Affiliation(s)
- H R Song
- Department of Orthopaedic Surgery, Gyeongsang University Hospital, Chinju, Korea
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31
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Abstract
PURPOSE To evaluate two families ascertained only for the presence of glaucoma in which both nail-patella syndrome and glaucoma occur in several generations and to determine whether the two diseases are genetically related. METHODS Ophthalmologic examinations and orthopedic examinations were performed. DNA samples from family members were screened with a microsatellite repeat marker at the argininosuccinate synthetase (ASS) locus at 9q34, and linkage analysis was performed. RESULTS Six patients with open-angle glaucoma were found among 13 patients with nail-patella syndrome in family UM:47. Seven patients with glaucoma were found among 11 patients with nail-patella syndrome in family UM:65. In both families, all individuals with glaucoma also had nail-patella syndrome. Two-point linkage analysis resulted in a lod score of 2.98 at a recombination fraction of 0.00 for open-angle glaucoma and nail-patella syndrome. CONCLUSIONS Linkage results presented here provide strong evidence that the orthopedic and nail anomalies in these two families result from the same nail-patella syndrome locus that has been previously linked to markers at 9q34. These data provide indirect evidence for a possible glaucoma locus at 9q34 and do not allow us to distinguish whether the glaucoma is the result of the nail-patella syndrome mutation or whether there is a separate locus responsible for glaucoma in these families. These studies suggest a need for ophthalmologic examination of individuals with nail-patella syndrome.
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Affiliation(s)
- P R Lichter
- Department of Ophthalmology, University of Michigan, Ann Arbor 48105, USA.
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32
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Kozlovskaia NL, Tareeva IE, Popova VV, Miroshnichenko NG, Stavrovskaia EV. [Kidney involvement in hereditary osteo-onychodysplasia]. TERAPEVT ARKH 1997; 69:37-9. [PMID: 9297271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Review of the literature and case report concern renal damage in hereditary osteo-onychodysplasia (nail-patella syndrome). This syndrome is a rare genetic disease inherited by the autosome-dominant type. It arises because of underdevelopment of tissues of mesodermal and ectodermal origin and is characterized by hypoplasia or absence of patella, ulnar dysplasia, nail plate dystrophy, growths on the iliac bones, renal affection. The disease was detected in early childhood. Renal affection presented with urinary syndrome with a concurrent nephrotic syndrome later on followed by moderate arterial hypertension and progression to renal failure. Renal biopsy revealed the picture of focal segmentary glomerular hyalinosis typical for this disorder. Because immunodepressants were thought inadequate, the treatment included lovastatin and inhibitors of angiotensin-converting enzyme to inhibit non-immune mechanisms of the disease progression.
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33
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Handa R, Wali JP, Aggarwal P. Proteinuria in a young man. Postgrad Med J 1997; 73:361-3. [PMID: 9246343 PMCID: PMC2431335 DOI: 10.1136/pgmj.73.860.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R Handa
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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34
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Lachiewicz PF, Herndon CD. Total knee arthroplasty for osteoarthritis in hereditary onycho-osteodysplasia (nail-patella syndrome): a case report. Am J Orthop (Belle Mead NJ) 1997; 26:129-30. [PMID: 9040887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Onycho-osteodysplasia is an unusual disorder that affects bone, fingernails, and the kidneys. The knees may be involved with a hypoplastic, dislocated patella, and premature osteoarthritis with deformity may develop. The following is a case report of a patient with this disorder in which a total knee arthroplasty was performed.
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Affiliation(s)
- P F Lachiewicz
- Department of Orthopedics, University of North Carolina School of Medicine, Chapel Hill, USA
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35
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Fujimoto S, Eto T, Hara S. [Nail patella syndrome]. Ryoikibetsu Shokogun Shirizu 1997:568-70. [PMID: 9277994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Fujimoto
- First Department of Internal Medicine, Miyazaki Medical College
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36
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Guleria R, Kumar S, Agarwal S, Prasad L. Renal failure with skeletal abnormalities. Postgrad Med J 1996; 72:569-70. [PMID: 8949600 PMCID: PMC2398559 DOI: 10.1136/pgmj.72.851.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R Guleria
- Department of Medicine, All India Institute of Medical Sciences, New Delhi
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37
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Abstract
A 5-year-old girl with nail-patella syndrome had diarrhea-associated hemolytic-uremic syndrome. Nail-patella syndrome is associated with a glomerulopathy characterized by the presence of fibrillar collagen within the glomerular basement membrane. Hemolytic-uremic syndrome has also been reported in patients with collagen type III glomerulopathy, a disorder also characterized by the presence of fibrillar collagen within the basement membrane. Patients with nail-patella syndrome or with collagen type III glomerulopathy may be predisposed to hemolytic-uremic syndrome.
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Affiliation(s)
- W L Robson
- Department of Pediatric Nephrology, Children's Hospital, Greenville Hospital System, SC 29605-4253, USA
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38
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39
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Mittal R, Saxena S, Hotchandani RK, Agarwal SK, Tiwari SC, Dash SC. Bilateral renal stones associated with nail-patella syndrome. Nephron Clin Pract 1994; 68:509. [PMID: 7870239 DOI: 10.1159/000188328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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40
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Abstract
We present here the first described case of Nail-patella syndrome (NPS) and pregnancy. Complications occurred during the pregnancy with the onset of preeclampsia at 22 weeks, leading to intrauterine fetal death at 24 weeks. The nephropathy of the NPS began clinically during the course of gestation. Postpartum, it persisted as isolated proteinuria, which became a nephrotic syndrome 18 months later.
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Affiliation(s)
- M Casellas
- Obstetrics and Gynaecology Department, Maternity and Infants' Hospital, Barcelona, Spain
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41
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Panace R, Mocarquer A, Anguita T, Cortés H. [Nail-patella syndrome associated with monoclonal gammopathy. Review regarding a case]. Rev Med Chil 1993; 121:59-64. [PMID: 8235167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 54 years old female with significant impairment of renal function is presented. On physical examination, the presence of dystrophic nails, elbow dysplasia and prominent iliac horns. Familial study showed similar nail and bone deformities in 3 of six sons. The nail patella syndrome diagnosis was based on these findings. This is a rare autosomal dominant hereditary disease, probably related to congenital alterations in collagen metabolism. Clinical characteristics include bone abnormalities that principally involve knees and elbows, nail alterations and the presence of iliac horns, that are considered pathognomonic of the syndrome. Renal involvement is observed in 30 to 55% of cases. This patient had also an IgA-lambda paraprotein, whose relationship to the above mentioned syndrome is uncertain, since no evidences of malignant plasma cell dyscrasia were demonstrated.
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Affiliation(s)
- R Panace
- Departamento de Nefrologia y Hematologia, Facultad de Medicina, Universidad de Chile (División Sur) Santiago
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42
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Abstract
This report describes a case of nail-patella syndrome in a woman with a strong family history who presented with effusions in her shoulder and knees. Microscopic examination of the shoulder fluid suggested the presence of calcium pyrophosphate dihydrate (CPPD) crystals, and examination of the knee fluid suggested both hydroxyapatite (HAP) and CPPD crystals. To our knowledge, the coexistence of these two conditions has not been reported in the past. Moreover, it brings up a new element regarding the inflammatory origin of the nail-patella syndrome.
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Affiliation(s)
- V T Papadakos
- Royal National Hospital for Rheumatic Diseases, Bath, UK
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43
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Hodson EM, Kluckow MR, O'Neill P. Clinical quiz. Nail-patella syndrome (NPS) (hereditary osteo-onychodysplasia). Pediatr Nephrol 1992; 6:314-6. [PMID: 1616848 DOI: 10.1007/bf00878390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- E M Hodson
- Department of Paediatrics, Westmead Hospital, New South Wales, Australia
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44
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Banskota AK, Mayo-Smith W, Rajbhandari S, Rosenthal DI. Case report 548: Nail-patella syndrome(hereditary onycho-osteodysplasia) with congenital absence of the fibulae. Skeletal Radiol 1989; 18:318-21. [PMID: 2675322 DOI: 10.1007/bf00361217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A K Banskota
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114
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45
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Loomer RL. Shoulder girdle dysplasia associated with nail patella syndrome. A case report and literature review. Clin Orthop Relat Res 1989:112-6. [PMID: 2642772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hereditary oncycho-osteodysplasia is a well-defined clinical entity consisting of four characteristics: (1) complete or partial absence of finger and thumb nails typically more severe on the radial side of the hand; (2) bony dysplasia about the knee consisting of patellar and lateral femoral condylar hypoplasia; (3) bony dysplasia about the elbow consisting of hypoplasia of the capitellum and radial head; and (4) iliac horns. The hereditary pattern is autosomal dominant with complete penetrance and variable expressivity. Other associated dysplasias have been reported, but there are only six articles reporting shoulder dysplasia and some of these are of questionable validity. This article reports the clinical and roentgenographic findings of a patient with an obvious deformity of the scapula consisting of a small acromion in both the anteroposterior (AP) and lateral planes. The acromion was deformed and slanted upwards at the lateral border. A slightly attenuated glenoid pointed laterally or slightly inferiorly, giving a humeral acromial interval of 2.5 cm.
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Affiliation(s)
- R L Loomer
- Department of Orthopedics, University of British Columbia, Canada
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46
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Browning MC, Weidner N, Lorentz WB. Renal histopathology of the nail-patella syndrome in a two-year-old boy. Clin Nephrol 1988; 29:210-3. [PMID: 3365866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A two-year-old child with the clinical stigmata of nail-patella syndrome, congenital urinary tract anomalies and proteinuria underwent renal biopsy. Electron microscopy revealed characteristic electron lucent areas and collagen fibril-like deposits in the glomerular basement membrane. Of special interest, electron dense deposits were seen in subendothelial areas of the capillary loops and immunofluorescent staining was striking, particularly for IgM, in a peripheral capillary loop pattern.
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Affiliation(s)
- M C Browning
- Department of Pediatrics, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103
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47
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Abstract
Ultrastructural renal lesions of a sporadic case of nail-patella syndrome are described. Although the patient, an 8-year-old Japanese boy, had no clinical renal syndrome, electron microscopy disclosed the presence of collagen fibrils and electron lucent areas within glomerular basement membrane. Comparative observation of glomeruli in sections stained by uranyl-acetate and lead-citrate and those by PTAH-uranyl revealed evidence of many collagen fibrils in mesangial matrix, as well as glomerular basement membrane. At the follow-up study 3 years after the biopsy, he still showed normal urinalysis and no renal dysfunction. Characteristic ultrastructure of glomerulus of this disease can be present even in cases without any apparent clinical renal involvement. It is concluded that the glomerular lesions in nail-patella syndrome may be caused by abnormal metabolic processes of collagen in glomeruli rather than entrapment of circulating collagen precursors.
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Affiliation(s)
- T Taguchi
- Department of Pathology and Pediatrics, School of Medicine, Fukuoka University, Japan
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48
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Abstract
Living-related renal transplantation was performed successfully in a patient with nail-patella syndrome. Graft biopsy 18 months post-transplantation showed normal glomerular basement membrane by electron microscopy. Dystrophic nails of both index fingers had also regrown, suggesting the donor kidney might replenish deficient factors.
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Affiliation(s)
- P C Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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49
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Harasawa H, Suzuki K, Yamamoto N, Itoh A, Yamazaki C, Masuko K. Nail-patella syndrome diagnosed during evaluation of chronic renal failure--report of two cases. Nihon Igaku Hoshasen Gakkai Zasshi 1987; 47:1560-5. [PMID: 3452789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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50
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Abstract
A 57 year old man with nail-patella syndrome (NPS) and associated renal disease is described who developed an inflammatory polyarthropathy and polyarteritis-like vasculitis. Vasculitis and serum complement abnormalities have not previously been reported in NPS. NPS is a rare autosomal dominant connective tissue disorder affecting both mesenchymal and ectodermal tissue. The condition is reviewed with particular reference to its renal pathology, including the distinctive electron microscopic (EM) finding of collagen deposition in the glomerular basement membrane (GBM). The possibility of the underlying collagen abnormality acting as a trigger for immune-inflammatory changes is discussed.
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Affiliation(s)
- A D Croock
- Medical University of South Carolina, Department of Medicine, Charleston 29425
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