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2015 ; 16
(ä): 92
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Identification of the first large deletion in the CLDN16 gene in a patient with
FHHNC and late-onset of chronic kidney disease: case report
#MMPMID26136118
Yamaguti PM
; dos Santos PA
; Leal BS
; Santana VB
; Mazzeu JF
; Acevedo AC
; Neves Fde A
BMC Nephrol
2015[Jul]; 16
(ä): 92
PMID26136118
show ga
BACKGROUND: Familial hypomagnesemia with hypercalciuria and nephrocalcinosis is a
rare autosomal recessive renal disease characterized by tubular disorders at the
thick ascending limb of Henle's loop. It is caused by mutations in the tight
junction structural proteins claudin-16 or claudin-19, which are encoded by the
CLDN16 and CLDN19 genes, respectively. Patients exhibit excessive wasting of
calcium and magnesium, nephrocalcinosis, chronic kidney disease, and early
progression to end-stage renal failure during infancy. CASE PRESENTATION: We here
report the phenotype and molecular analysis of a female Brazilian patient with a
novel large homozygous deletion in the CLDN16 gene. The proband, born from
consanguineous parents, presented the first symptoms at age 20. Clinical
examination revealed hypocalcemia, hypomagnesemia, nephrocalcinosis, mild myopia,
high serum levels of uric acid and intact parathyroid hormone, and moderate
chronic kidney disease (stage 3). She and her mother were subjected to CLDN16 and
CLDN19 mutational analysis. In addition, the multiplex ligation-dependent probe
amplification method was used to confirm a CLDN16 multi-exon deletion. Direct
sequencing revealed a normal CLDN19 sequence and suggested a large deletion in
the CLDN16 gene. Multiplex ligation-dependent probe amplification showed a
homozygous CLDN16 multi-exon deletion (E2_E5del). The patient initiated
conventional treatment for familial hypomagnesemia with hypercalciuria and
nephrocalcinosis and progressed to end-stage kidney disease after five years.
CONCLUSIONS: This study provides the first report of a large homozygous deletion
in the CLDN16 gene causing familial hypomagnesemia with hypercalciuria and
nephrocalcinosis with late onset of the first symptoms. This description expands
the phenotypic and genotypic characterization of the disease. The late-onset
chronic kidney disease in the presence of a homozygous deletion in the CLDN16
gene reinforces the great variability of genotype-phenotype manifestation in
patients with familial hypomagnesemia with hypercalciuria and nephrocalcinosis.