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2017 ; 10
(1
): 539
Nephropedia Template TP
gab.com Text
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English Wikipedia
The first Sri Lankan family with Dent disease-1 due to a pathogenic variant in
the CLCN5 gene: a case report
#MMPMID29084614
Ranawaka R
; Sirisena ND
; Dayasiri KC
; Cogal AG
; Lieske JC
; Gamage MP
; Dissanayake VHW
BMC Res Notes
2017[Oct]; 10
(1
): 539
PMID29084614
show ga
BACKGROUND: Dent disease-1 is a rare X-linked recessive renal tubular disorder
caused by pathogenic variants in the chloride voltage-gated channel 5 (CLCN5)
gene. It is characterized by low-molecular-weight proteinuria, hypercalciuria,
nephrocalcinosis, nephrolithiasis and progressive renal failure. This is the
first report of a CLCN5 pathogenic variant in a Dent disease-1 family of Sri
Lankan origin, and it highlights the value of genetic evaluation in children with
refractory proteinuria. CASE PRESENTATION: A 2-year-old boy with non-nephrotic
range proteinuria was referred for evaluation. His maternally related 24-year-old
uncle had been investigated for similar features at the age of 14 years and his
renal histology had shown few sclerosed glomeruli. He remained asymptomatic apart
from proteinuria. Biochemical investigation of the child showed ?-2
microglobulinuria and hypercalciuria. After providing pre-test counseling and
obtaining written informed consent, the child, his mother and maternal uncle
underwent genetic testing for confirmation of the clinically suspected diagnosis
of Dent disease-1. Both the child and his maternal uncle were found to be
hemizygous for a nonsense pathogenic variant in exon 9 of the CLCN5 gene
[NM_000084.4; c.1399C>T; rs797044811] which results in a stop codon at residue
467, leading to a truncated non-functional protein [NP_000075.1; p.R467X]. His
mother was confirmed to be an unaffected heterozygous carrier for the same
variant. Following confirmation of the diagnosis our patient was started on
thiazide diuretics and potassium citrate. CONCLUSIONS: Even though the typical
phenotype of Dent disease-1 often enables a clinical diagnosis to be made, less
severe sub-clinical cases may go undiagnosed. The underlying diagnosis may be
missed especially in children who are treated for non-minimal change nephrotic
syndrome with steroids. This case highlights the need for tubular proteinuria to
be considered in the differential diagnosis of children with refractory
proteinuria and for appropriate genetic evaluation to be done to confirm the
precise underlying diagnosis in such cases.