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2017 ; 18
(1
): 220
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Nephron development and extrarenal features in a child with congenital nephrotic
syndrome caused by null LAMB2 mutations
#MMPMID28683731
Kino J
; Tsukaguchi H
; Kimata T
; Nguyen HT
; Nakano Y
; Miyake N
; Matsumoto N
; Kaneko K
BMC Nephrol
2017[Jul]; 18
(1
): 220
PMID28683731
show ga
BACKGROUND: Congenital nephrotic syndrome (CNS) is a rare disorder caused by
various structural and developmental defects of glomeruli. It occurs typically as
an isolated kidney disorder but associates sometimes with other systemic,
extrarenal manifestations. CASE PRESENTATIONS: An infant presented with severe
CNS, which progressed rapidly to renal failure at age of 3 months and death at
27 months. The clinical phenotypes and genetic causes were studied, including the
renal pathology at autopsy. Besides the CNS, the affected child had remarkable
right-side predominant eye-ball hypoplasia with bilateral anterior chamber
dysgenesis (microcoria). Brain MRI revealed grossly normal development in the
cerebrum, cerebellum, and brain stem. Auditory brainstem responses were
bilaterally blunted, suggesting a defective auditory system. At autopsy, both
kidneys were mildly atrophied with persistent fetal lobulation. Microscopic
examination showed a diffuse global sclerosis. However, despite of the smaller
size of glomeruli, the nephron number remained similar to that of the age-matched
control. Whole-exome sequencing revealed that the affected child was compound
heterozygous for novel truncating LAMB2 mutations: a 4-bp insertion
(p.Gly1693Alafs*8) and a splicing donor-site substitution (c.1225 + 1G > A),
presumably deleting the coiled-coil domains that form the laminin 5-2-1
heterotrimer complex. CONCLUSIONS: Our case represents a variation of Pierson
syndrome that accompanies CNS with unilateral ocular hypoplasia. The average
number but smaller glomeruli could reflect either mal-development or
glomerulosclerosis. Heterogeneous clinical expression of LAMB2 defects may
associate with the difference in fetal ?1 subtype compensation among affected
tissues. Further study is necessary to evaluate incidence and features of
auditory defect under LAMB2 deficiency.