H Mukdsi Jorge, Gutiérrez Silvina, Barrón Belén, Novoa Pablo, Fernández Segundo, de Diller Ana B, I Torres Alicia, Formica Richard N, Orías Marcelo
Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, and Haya de la Torre esquina Enrique Barros, Ciudad Universitaria, Córdoba, Argentina.
Servicio de Nefrología, Sanatorio Allende, Bernardo de Irigoyen 384, Córdoba, Argentina.
J Nephropathol. 2012 Oct;1(3):194-7. doi: 10.5812/nephropathol.8123. Epub 2012 Oct 1.
Fabry disease is caused by an X-linked recessive inborn error of glycosphingolipid metabolism with deficient activity of a lysosomal enzyme, alpha-galactosidase A (α-GalA).
A 46 year-old man with progressive kidney disease showed on kidney biopsy electron microscopic evidence of Fabry disease. The patient had no systemic manifestations of Fabry disease, despite residual α-GalA activity, therefore genetic testing was done by direct DNA sequencing, demonstrating a new GAL A gene mutation (C174G-exon 3). After three years of enzyme replacement therapy (agalsidase beta) treatment, a second biopsy was done. Although there was demonstrable clearance of intracellular inclusions, remarkable podocyte activation was evident.
This report represents an unusual renal variant of Fabry disease and provides histologic data on long-term follow up after enzyme replacement therapy.
法布里病是由X连锁隐性遗传性鞘糖脂代谢紊乱引起的,其溶酶体酶α-半乳糖苷酶A(α-GalA)活性缺乏。
一名患有进行性肾病的46岁男性,肾脏活检的电子显微镜检查显示有法布里病的证据。尽管患者仍有残余的α-GalA活性,但并无法布里病的全身表现,因此通过直接DNA测序进行基因检测,结果显示存在一种新的GAL A基因突变(C174G-外显子3)。在接受三年的酶替代疗法(阿加糖酶β)治疗后,进行了第二次活检。虽然细胞内包涵体明显清除,但足细胞显著活化。
本报告描述了一种不常见的法布里病肾脏变异型,并提供了酶替代疗法长期随访的组织学数据。