Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France.
Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France; Pediatric Nephrology, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France.
Kidney Int. 2018 Nov;94(5):1013-1022. doi: 10.1016/j.kint.2018.07.024.
Monogenic forms of Steroid-Resistant Nephrotic Syndrome (SRNS) have been widely characterized, but genetic screening paradigms preferentially address congenital, infantile onset, and familial cases. Our aim was to characterize the distribution of disease-causing gene mutations in adults with sporadic SRNS or focal segmental glomerulosclerosis (FSGS). We selected adult patients with non-syndromic, biopsy-proven FSGS or SRNS in the absence of known family history. Strict clinical criteria included lack of response to glucocorticoids and cyclosporine, and no recurrence after kidney transplantation. Mutations in SRNS genes were detected using a targeted gene panel. Sixteen of 135 tested participants (11.8%) carried pathogenic mutations in monogenic SRNS genes, and 14 others (10.4%) carried two APOL1 high-risk alleles. Autosomal recessive disease was diagnosed in 5 participants, autosomal dominant disease in 9, and X-linked disease in 2. Four participants carried a de novo heterozygous mutation. Among the 16 participants with identified mutations in monogenic SNRS genes, 7 (43.7%) had type IV collagen mutations. Mutations in monogenic SNRS genes were identified primarily in participants with proteinuria onset before 25 years of age, while the age at disease onset was variable in those with APOL1 high-risk genotype. Mean age at diagnosis was lower and renal survival was worse in participants with identified mutations in SNRS genes than in those without mutations. We found a significant rate of pathogenic mutations in adults with SRNS, with Type IV collagen mutations being the most frequent. These findings may have immediate impact on clinical practice.
单基因形式的类固醇抵抗性肾病综合征 (SRNS) 已得到广泛研究,但遗传筛查模式主要针对先天性、婴儿期发病和家族性病例。我们的目的是描述散发性 SRNS 或局灶节段性肾小球硬化症 (FSGS) 成年患者中致病基因突变的分布。我们选择了非综合征性、经活检证实的 FSGS 或 SRNS 且无已知家族史的成年患者。严格的临床标准包括对糖皮质激素和环孢素无反应,以及肾移植后无复发。使用靶向基因 panel 检测 SRNS 基因的突变。在 135 名接受测试的参与者中,有 16 名(11.8%)携带单基因 SRNS 基因的致病性突变,另有 14 名(10.4%)携带两个 APOL1 高危等位基因。5 名参与者诊断为常染色体隐性疾病,9 名诊断为常染色体显性疾病,2 名诊断为 X 连锁疾病。4 名参与者携带新的杂合突变。在 16 名携带单基因 SNRS 基因突变的参与者中,有 7 名(43.7%)存在 IV 型胶原突变。单基因 SNRS 基因突变主要在蛋白尿发病年龄<25 岁的参与者中发现,而具有 APOL1 高危基因型的参与者的发病年龄则各不相同。在 SNRS 基因突变的参与者中,诊断时的平均年龄较低,肾脏存活率较差。我们发现,SRNS 成年患者存在较高的致病性突变率,其中 IV 型胶原突变最为常见。这些发现可能会对临床实践产生直接影响。