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2015 ; 4
(ä): 492
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Nephrolithiasis, kidney failure and bone disorders in Dent disease patients with
and without CLCN5 mutations
#MMPMID26389017
Anglani F
; D'Angelo A
; Bertizzolo LM
; Tosetto E
; Ceol M
; Cremasco D
; Bonfante L
; Addis MA
; Del Prete D
Springerplus
2015[]; 4
(ä): 492
PMID26389017
show ga
Dent disease (DD) is a rare X-linked recessive renal tubulopathy characterised by
low-molecular-weight proteinuria (LMWP), hypercalciuria, nephrocalcinosis and/or
nephrolithiasis. DD is caused by mutations in both the CLCN5 and OCRL genes.
CLCN5 encodes the electrogenic chloride/proton exchanger ClC-5 which is involved
in the tubular reabsorption of albumin and LMW proteins, OCRL encodes the
inositol polyphosphate 5-phosphatase, and was initially associated with Lowe
syndrome. In approximately 25 % of patients, no CLCN5 and OCRL mutations were
detected. The aim of our study was to evaluate whether calcium phosphate
metabolism disorders and their clinical complications are differently distributed
among DD patients with and without CLCN5 mutations. Sixty-four male subjects were
studied and classified into three groups: Group I (with CLCN5 mutations), Group
II (without CLCN5 mutations) and Group III (family members with the same CLCN5
mutation). LMWP, hypercalciuria and phosphaturic tubulopathy and the consequent
clinical complications nephrocalcinosis, nephrolithiasis, bone disorders, and
chronic kidney disease (CKD) were considered present or absent in each patient.
We found that the distribution of nephrolithiasis, bone disorders and CKD differs
among patients with and without CLCN5 mutations. Only in patients harbouring
CLCN5 mutations was age-independent nephrolithiasis associated with
hypercalciuria, suggesting that nephrolithiasis is linked to altered proximal
tubular function caused by a loss of ClC-5 function, in agreement with ClC-5 KO
animal models. Similarly, only in patients harbouring CLCN5 mutations was
age-independent kidney failure associated with nephrocalcinosis, suggesting that
kidney failure is the consequence of a ClC-5 dysfunction, as in ClC-5 KO animal
models. Bone disorders are a relevant feature of DD phenotype, as patients were
mainly young males and this complication occurred independently of age. The triad
of symptoms, LMWP, hypercalciuria, and nephrocalcinosis, was present in almost
all patients with CLCN5 mutations but not in those without CLCN5 mutations. This
lack of homogeneity of clinical manifestations suggests that the difference in
phenotypes between the two groups might reflect different pathophysiological
mechanisms, probably depending on the diverse genes involved. Overall, our
results might suggest that in patients without CLCN5 mutations several genes
instead of the prospected third DD underpin patients' phenotypes.