Diagnosis of Alport syndrome and thin basement membrane nephropathy in childhood
 
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Klinika Nefrologii Dziecięcej, Uniwersytet Jagielloński Collegium Medicum w Krakowie
 
 
Corresponding author
Anna Moczulska   

Klinika Nefrologii Dziecięcej, Uniwersytet Jagielloński Collegium Medicum w Krakowie, ul. Wielicka 265, 30-663 Kraków
 
 
Ann. Acad. Med. Siles. 2017;71:73-81
 
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ABSTRACT
Introduction:
The Alport syndrome (AS) and thin basement membrane nephropathy (TBMN) are glomerulopathies of genetic origin difficult to differentiate, with no predictors of a long term outcome. The aim of the study was to analyze clinical data regarding kidney histopathology in children with AS and TBMN.

Material and methods:
The study group consisted of 53 children (27 girls) aged 9.5 years, treated for AS (n = 25) or TBMN (n = 28) at University Children's Hospital of Cracow between 1988–2015. The kidney biopsy result was correlated with clinical data in both groups using Statistica12 (Statsoft).

Results:
Hematuria was diagnosed in all the children at the age of 1–17 (median 6 years) and proteinuria in 14 patients with AS (56%). The follow-up time before biopsy was longer in TBMN – 38 vs. 11 months (p = 0.01). In 11 (39%) TBMN patients mesangial proliferation was observed. Among the AS patients in 4 cases (16%) no kidney pathology was found. Multiple regression analysis indicated an irregular basement membrane structure as the most significant predictor for proteinuria (R2 = 0.56, p = 0.011). Therapy with ACEI was introduced in 14 patients with proteinuria, prednisone in 8 patients, cyclosporine A in 8 and methylprednisolone pulses in 2. Two boys progressed to end stage renal failure before the age of 18 years. Two patients with TBMN developed proteinuria in later follow-ups.

Conclusions:
Proteinuria and irregularity of basement membrane in children with AS and TBMN are predictors of poor prognosis. Hematuria and thinning of basal membrane do not ensure benign follow-up. Early kidney biopsy in young children with isolated hematuria seems to be not useful. Intorduction of genetical testing is needed for early diagnosig instead.

 
REFERENCES (24)
1.
Ritchie C.D., Bevan E.A., Collier S.J. Importance of occult haematuria found at screening. Br. Med. J. (Clin Res Ed). 1986; 292(6521): 681–683.
 
2.
Savige J., Rana K., Tonna S., Buzza M., Dagher H., Wang Y.Y. Thin basement membrane nephropathy. Kidney Int. 2003; 64: 1169–1178.
 
3.
Hasstedt S.J., Atkin C.L. X-linked inheritance of Alport syndrome: family P revisited. Am. J. Hum. Genet. 1983; 35: 1241–1251.
 
4.
Mencarelli M.A., Heidet L., Storey H., van Geel M., Knebelmann B., Fallerini C., Miglietti N., Antonucci M.F., Cetta F., Sayer J.A., van den Wijngaard A., Yau S., Mari F., Bruttini M., Ariani F., Dahan K., Smeets B., Antignac C., Flinter F., Renieri A. Evidence of digenic inheritance in Alport syndrome. J. Med. Genet. 2015; 52(3): 163–174.
 
5.
Rana K., Tonna S., Wang Y.Y., Sin L., Lin T., Shaw E., Mookerjee I., Savige J. Nine novel COL4A3 and COL4A4 mutations and polymorphisms identified in inherited membrane diseases. Pediatr. Nephrol. 2007; 22(5): 652–657.
 
6.
Hudson B.G., Tryggvason K., Sundaramoorthy M., Neilson E.G. Alport's syndrome, Goodpasture's syndrome, and type IV collagen. N. Engl. J. Med. 2003; 348: 2543–2556.
 
7.
Tryggvason K., Patrakka J. Thin basement membrane nephropathy. J. Am. Soc. Nephrol. 2006; 17: 813–822.
 
8.
Zurawski J., Burchardt P., Moczko J., Seget M, Iwanik K, Sikora J, Woźniak A, Salwa-Zurawska W. Morphological assessment of thin basement membrane disease. Pol. J. Pathol. 2016; 67: 114–121.
 
9.
Vogler C., McAdams A.J., Homan S.M. Glomerular basement membrane and lamina densa in infants and children: an ultrastructural evaluation. Pediatr. Pathol. 1987; 7: 527–534.
 
10.
Cangiotti A.M., Sessa A., Meroni M., Montironi R., Ragaiolo M., Mambelli V., Cinti S. Evolution of glomerular basement membrane lesions in a male patient with Alport syndrome: ultrastructural and morphometric study. Nephrol. Dial. Transplant. 1996; 11: 1829–1834.
 
11.
Pierides A., Voskarides K., Athanasiou Y., Ioannou K., Damianou L., Arsali M., Zavros M., Pierides M., Vargemezis V., Patsias C., Zouvani I., Elia A., Kyriacou K., Deltas C. Clinico-pathological correlations in 127 patients in 11 large pedigrees, segregating one of three heterozygous mutations in the COL4A3/ COL4A4 genes associated with familial haematuria and significant late progression to proteinuria and chronic kidney disease from focal segmental glomerulosclerosis. Nephrol. Dial. Transplant. 2009; 24: 2721–2729.
 
12.
Kruegel J., Rubel D., Gross O. Alport syndrome--insights from basic and clinical research. Nat. Rev. Nephrol. 2013; 9: 170–178.
 
13.
Jais J.P., Knebelmann B., Giatras I., De Marchi M., Rizzoni G., Renieri A., Weber M., Gross O., Netzer K.O., Flinter F., Pirson Y., Dahan K., Wieslander J., Persson U., Tryggvason K., Martin P., Hertz J.M., Schröder C., Sanak M., Carvalho M.F., Saus J., Antignac C., Smeets H., Gubler M.C. X-linked Alport syndrome: natural history and genotype-phenotype correlations in girls and women belonging to 195 families: a "European Community Alport Syndrome Concerted Action" study. J. Am. Soc. Nephrol. 2003; 14: 2603–2610.
 
14.
Savige J., Ratnaike S., Colville D. Retinal abnormalities characteristic of inherited renal disease. J. Am. Soc. Nephrol. 2011; 22: 1403–1415.
 
15.
Barker D.F., Hostikka S.L., Zhou J., Chow L.T., Oliphant A.R., Gerken S.C., Gregory M.C., Skolnick M.H., Atkin C.L., Tryggvason K. Identification of mutations in the COL4A5 collagen gene in Alport syndrome. Science. 1990; 248(4960): 1224–1227.
 
16.
Mochizuki T., Lemmink H.H., Mariyama M., Antignac C., Gubler M.C., Pirson Y., Verellen-Dumoulin C., Chan B., Schröder C.H., Smeets H.J. Identification of mutations in the alpha 3(IV) and alpha 4(IV) collagen genes in autosomal recessive Alport syndrome. Nat. Genet. 1994; 8: 77–81.
 
17.
Feingold J., Bois E., Chompret A., Broyer M., Gubler M.C., Grunfeld J.P. Genetic heterogeneity of Alport syndrome. Kidney Int. 1985; 27: 672–677.
 
18.
Ninomiya Y., Kagawa M., Iyama K., Naito I., Kishiro Y., Seyer J.M., Sugimoto M., Oohashi T., Sado Y. Differential expression of two basement membrane collagen genes, COL4A6 and COL4A5, demonstrated by immunofluorescence staining using peptide-specific monoclonal antibodies. J. Cell. Biol. 1995; 130: 1219–1229.
 
19.
Kalluri R., Shield C.F., Todd P., Hudson B.G., Neilson E.G. Isoform switching of type IV collagen is developmentally arrested in X-linked Alport syndrome leading to increased susceptibility of renal basement membranes to endoproteolysis. J. Clin. Invest. 1997; 99: 2470–2478.
 
20.
Storey H., Savige J., Sivakumar V., Abbs S., Flinter F.A. COL4A3/COL4A4 mutations and features in individuals with autosomal recessive Alport syndrome. J. Am. Soc. Nephrol. 2013; 24: 1945–1954.
 
21.
Bekheirnia M.R., Reed B., Gregory M.C., McFann K., Shamshirsaz A.A., Masoumi A., Schrier R.W. Genotype-phenotype correlation in X-linked Alport syndrome. J. Am. Soc. Nephrol. 2010; 21: 876–883.
 
22.
Fallerini C., Baldassarri M., Trevisson E., Morbidoni V., La Manna A., Lazzarin R., Pasini A., Barbano G., Pinciaroli A.R., Garosi G., Frullanti E., Pinto A.M., Mencarelli M.A., Mari F., Renieri A., Ariani F. Alport syndrome: impact of digenic inheritance in patients management. Clin. Genet. 2016, doi: 10.1111/cge.12919.
 
23.
Massella L., Muda A.O., Legato A., Di Zazzo G., Giannakakis K., Emma F. Cyclosporine A treatment in patients with Alport syndrome: a single-center experience. Pediatr. Nephrol. 2010; 25: 1269–1275.
 
24.
Sugimoto K., Fujita S., Miyazawa T., Nishi H., Enya T., Izu A., Wada N., Sakata N., Okada M., Takemura T. Cyclosporin A may cause injury to undifferentiated glomeruli persisting in patients with Alport syndrome. Clin. Exp. Nephrol. 2014; 18: 492–498.
 
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