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2012 ; 5
(3
): 195-202
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Aquaporin-2: new mutations responsible for autosomal-recessive nephrogenic
diabetes insipidus-update and epidemiology
#MMPMID26069764
Bichet DG
; El Tarazi A
; Matar J
; Lussier Y
; Arthus MF
; Lonergan M
; Bockenhauer D
; Bissonnette P
Clin Kidney J
2012[Jun]; 5
(3
): 195-202
PMID26069764
show ga
It is clinically useful to distinguish between two types of hereditary
nephrogenic diabetes insipidus (NDI): a 'pure' type characterized by loss of
water only and a complex type characterized by loss of water and ions. Patients
with congenital NDI bearing mutations in the vasopressin 2 receptor gene, AVPR2,
or in the aquaporin-2 gene, AQP2, have a pure NDI phenotype with loss of water
but normal conservation of sodium, potassium, chloride and calcium. Patients with
hereditary hypokalemic salt-losing tubulopathies have a complex phenotype with
loss of water and ions. They have polyhydramnios, hypercalciuria and hypo- or
isosthenuria and were found to bear KCNJ1 (ROMK) and SLC12A1 (NKCC2) mutations.
Patients with polyhydramnios, profound polyuria, hyponatremia, hypochloremia,
metabolic alkalosis and sensorineural deafness were found to bear BSND mutations.
These clinical phenotypes demonstrate the critical importance of the proteins
ROMK, NKCC2 and Barttin to transfer NaCl in the medullary interstitium and
thereby to generate, together with urea, a hypertonic milieu. This editorial
describes two new developments: (i) the genomic information provided by the
sequencing of the AQP2 gene is key to the routine care of these patients, and, as
in other genetic diseases, reduces health costs and provides psychological
benefits to patients and families and (ii) the expression of AQP2 mutants in
Xenopus oocytes and in polarized renal tubular cells recapitulates the clinical
phenotypes and reveals a continuum from severe loss of function with urinary
osmolalities <150 mOsm/kg H2O to milder defects with urine osmolalities >200
mOsm/kg H2O.