Carriers of Autosomal Recessive Alport Syndrome with Thin Basement Membrane Nephropathy Presenting as Focal Segmental Glomerulosclerosis in Later Life
| Autor: | Constantinou-Deltas, Constantinos D., Savva, Isavella, Voskarides, Konstantinos, Papazachariou, Louiza, Pierides, Alkis M. |
|---|---|
| Přispěvatelé: | Constantinou-Deltas, Constantinos D. [0000-0001-5549-9169] |
| Rok vydání: | 2015 |
| Předmět: |
Collagen Type IV
Pathology medicine.medical_specialty Heterozygote Population Nephritis Hereditary urologic and male genital diseases Glomerulonephritis Membranous Nephropathy Focal segmental glomerulosclerosis collagen type 4 nephritis Molecular genetics medicine Humans genetics human Alport syndrome education education.field_of_study medicine.diagnostic_test business.industry Glomerulosclerosis Focal Segmental disease course Glomerulosclerosis Glomerulonephritis medicine.disease heterozygote female genital diseases and pregnancy complications COL4A5 protein human Disease Progression pathology Renal biopsy focal glomerulosclerosis membranous glomerulonephritis business COL4A4 protein human |
| Zdroj: | Nephron |
| ISSN: | 2235-3186 |
| Popis: | Collagen IV nephropathies (COL4Ns) comprise benign familial microscopic hematuria, thin basement membrane nephropathy (TBMN), X-linked Alport syndrome (AS) and also autosomal recessive and dominant AS. Apart from the X-linked form of AS, which is caused by hemizygous mutations in the COL4A5 gene, the other entities are caused by mutations in the COL4A3 or COL4A4 genes. The diagnosis of these conditions used to be based on clinical and/or histological findings of renal biopsies, but it is the new molecular genetics approach that revolutionised their investigation and proved particularly instrumental, especially, in many not so clear-cut cases. More recently, the spectrum of COL4N has expanded to include late onset focal segmental glomerulosclerosis (FSGS) that develops on top of TBMN in later life. Also, other reports showed that some patients with a primary diagnosis of familial FSGS proved to have variants in COL4 genes. In the presence of a renal biopsy picture of FSGS and in the absence of either electron microscopy studies or molecular genetic studies that point to TBMN and COL4N, the patient and his family may be mistakenly diagnosed with hereditary FSGS leading to unnecessary further investigations, erroneous family counselling and improper corticosteroid treatment. TBMN is a frequent finding in the general population, and according to several recent reports, it may be the underlying cause and the explanation for many familial and sporadic cases of late-onset FSGS with non-nephrotic proteinuria. This is an important new finding that needs widespread recognition. It is anticipated that the molecular genetic analysis with next generation sequencing will certainly offer timely correct diagnosis. |
| Databáze: | OpenAIRE |
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