陈国强, 张小鸽, 李志娟, 成银萍. 儿童Dent病临床特点及CLCN5基因突变分析[J]. 临床肾脏病杂志, 2017, 17(7): 403-406. DOI: 10.3969/j.issn.1671-2390.2017.07.005
    引用本文: 陈国强, 张小鸽, 李志娟, 成银萍. 儿童Dent病临床特点及CLCN5基因突变分析[J]. 临床肾脏病杂志, 2017, 17(7): 403-406. DOI: 10.3969/j.issn.1671-2390.2017.07.005
    CHEN Guo-qiang, ZHANG Xiao-ge, LI Zhi-juan, CHENG Yin-ping. Clinical and CLCN5 genetic mutation analysis of Dent's disease in children[J]. Journal of Clinical Nephrology, 2017, 17(7): 403-406. DOI: 10.3969/j.issn.1671-2390.2017.07.005
    Citation: CHEN Guo-qiang, ZHANG Xiao-ge, LI Zhi-juan, CHENG Yin-ping. Clinical and CLCN5 genetic mutation analysis of Dent's disease in children[J]. Journal of Clinical Nephrology, 2017, 17(7): 403-406. DOI: 10.3969/j.issn.1671-2390.2017.07.005

    儿童Dent病临床特点及CLCN5基因突变分析

    Clinical and CLCN5 genetic mutation analysis of Dent's disease in children

    • 摘要: 目的 Dent病是一种罕见的X连锁隐性遗传性肾小管疾病,通过探讨儿童Dent病的临床特点和基因特征,旨在提高对儿童Dent病的认识。方法 通过分析3例Dent病患儿的临床资料和CLCN5基因检测结果,复习相关文献,以了解Dent病的表型和基因型,并总结经验。结果 3例患儿的发病年龄1~5岁,确诊年龄1~7岁,首发症状为大量蛋白尿,且证实为低分子蛋白尿,伴有不同程度的高钙尿症,均有镜下血尿。3例患儿的乳酸脱氢酶均正常,均无高血压,无肾功能不全,无贫血,无肾结石或肾钙质沉着症,无肾小管酸中毒,无佝偻病,无矮小症,无智力低下,眼科检查正常,无氨基酸尿及糖尿,无肾脏疾病或尿石症家族史,血清尿素氮、肌酐、白蛋白、钾、钠、氯、钙、镁、磷均正常。基因检测发现3种突变,2例错义突变,1例移码突变,3例患儿均为新生突变;其中c.779G>A突变位点为既往文献报道过的位点,另外发现两个新的突变位点c.1711C>T(E12),c.458(E7)_c.459(E7) insA,既往文献无报道,为新的突变。结论 儿童Dent病临床表现多样,并且临床表现和病程长短有关,通过基因检测可以确诊Dent病。早期发现、早期诊断,可以避免过度免疫抑制及治疗。

       

      Abstract: Objective Dent disease is a rare X-linked recessive renal tubular disease. This study aimed to enhance the recognition of dent disease by exploring the clinical characteristics and genetic features.Methods Methods The clinical data of 3 children with Dent disease, genetic test results for CLCN5, and relevant literatures were analyzed retrospectively for further recognizing the clinical/genetic phenotype of Dent disease and subsequently summarizing experience.Results The onset age of 3 children was 1-5 years, while the age at diagnosis was 1-7 years. Massive proteinuria, which was subsequently proved to be low molecular weight proteinuria (LMWP), was defined as the initial symptom in all patients. Meanwhile, varying degrees of hypercalciuria and microhematuria were also observed. All 3 patients displayed normal activity of lactate dehydrogena, no hypertension, no renal insufficiency, no anemia, no renal calculus or nephrocalcinosis, no renal tubular acidosis, no rickets or dwarfism, no mental retardation, normal ophthalmic examination, no aminoaciduria or glycosuria, no family history of kidney diseases, and normal level of serum urea nitrogen, creatinine, albumin, potassium, sodium, chlorine, calcium, magnesium and phosphate. Genetic testing demonstrated 3 de novo mutations:2 of missense mutation and 1 of phase-shift mutation. Among them, the mutation of c.779G>A had been reported in previous studies, while others of c.1711C>T(E12) and c.458 (E7)_c.459(E7)insA were the first discovered mutations.Conclusions The clinical manifestations of Dent disease, which are also related to the disease course, are varied among children. Early detection and diagnosis of Dent disease by genetic testing may be an effective strategy to avoid excessive immunosuppressive-therapy.

       

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