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[两例具有巴特综合征样表型的1型丹特病及文献复习]

[Two cases of Dent disease type 1 with Bartter-like phenotype and literature review].

作者信息

Cheng M, Meng X, Liu M, Gong C X

机构信息

Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Sep 3;104(34):3256-3259. doi: 10.3760/cma.j.cn112137-20240315-00587.

Abstract

The clinical presentation, treatment, and follow-up of two boys with type 1 Dent disease who exhibited a Bartter-like phenotype were retropectively analysed. The related literature of pediatric patients with type 1 Dent disease who had hypokalemia and metabolic alkalosis was screened through databases such as PubMed, CNKI, and Wanfang until February 1, 2024, and common features among these patients were summarized through literature review. A total of 7 literatures were included, and 9 children were included in the analysis. All patients were male, presenting with significant low molecular weight proteinuria and hypercalciuria. Other prominent characteristic phenotypes included short stature (7/8), hypophosphatemia (8/9), and rickets (6/8). Seven previously reported patients had missense or nonsense mutations, while 2 patients in this study carried possible pathogenic mutations in the CLCN5 gene, c.315+2T>A (p.?) and c.584dupT (p.I196Yfs*6), respectively. Five patients were able to maintain blood potassium levels around 3 mmol/L with oral potassium chloride solution combined with non-steroidal anti-inflammatory drugs (ibuprofen or indomethacin). The follow-up showed that 2 patients developed chronic kidney disease stage 4 and stage 3 at the age of 13 and 21 years, respectively. The phenotypic overlap between Dent disease and Batter syndrome is considerable,with the distinguishing feature being the presence of significant low molecular weight proteinuria. Patients with type 1 Dent disease presenting with the Bartter-like phenotype have a high prevalence of short stature, hypophosphatemia, and rickets. Non-steroidal anti-inflammatory drugs can be used to correct hypokalemia in patients under periodic renal function assessment.

摘要

对两名表现出巴特综合征样表型的1型丹特病男孩的临床表现、治疗及随访情况进行了回顾性分析。通过PubMed、CNKI和万方等数据库检索截至2024年2月1日患有低钾血症和代谢性碱中毒的1型丹特病儿科患者的相关文献,并通过文献综述总结这些患者的共同特征。共纳入7篇文献,分析了9例患儿。所有患者均为男性,表现为显著的低分子量蛋白尿和高钙尿症。其他突出的特征性表型包括身材矮小(7/8)、低磷血症(8/9)和佝偻病(6/8)。先前报道的7例患者有错义或无义突变,而本研究中的2例患者分别在CLCN5基因中携带可能的致病突变,即c.315+2T>A(p.?)和c.584dupT(p.I196Yfs*6)。5例患者通过口服氯化钾溶液联合非甾体类抗炎药(布洛芬或吲哚美辛)能够将血钾水平维持在3 mmol/L左右。随访显示,2例患者分别在13岁和21岁时发展为慢性肾脏病4期和3期。丹特病与巴特综合征之间的表型重叠相当大,其区别特征是存在显著的低分子量蛋白尿。表现出巴特综合征样表型的1型丹特病患者身材矮小、低磷血症和佝偻病的患病率较高。在定期进行肾功能评估的情况下,非甾体类抗炎药可用于纠正患者的低钾血症。

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