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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Front+Pediatr
2018 ; 6
(ä): 200
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Exploring the Clinical and Genetic Spectrum of Steroid Resistant Nephrotic
Syndrome: The PodoNet Registry
#MMPMID30065916
Trautmann A
; Lipska-Zi?tkiewicz BS
; Schaefer F
Front Pediatr
2018[]; 6
(ä): 200
PMID30065916
show ga
Background: Steroid resistant nephrotic syndrome (SRNS) is a rare condition,
accounting for 10-15% of all children with idiopathic nephrotic syndrome. SRNS
can be caused by genetic abnormalities or immune system dysfunction. The
prognosis of SRNS varies from permanent remission to progression to end-stage
kidney disease, and post-transplant recurrence is common. Objectives: The PodoNet
registry project aims to explore the demographics and phenotypes of
immune-mediated and genetic forms of childhood SRNS, to assess genotype-phenotype
correlations, to evaluate clinical management and long-term outcomes, and to
search for novel genetic entities and diagnostic and prognostic biomarkers in
SRNS. Methods: In 2009, an international registry for SRNS was established to
collect retro- and prospective information on renal and extrarenal disease
manifestations, histopathological and genetic findings and information on family
history, pharmacotherapy responsiveness and long-term outcomes. To date, more
than 2,000 patients have been enrolled at 72 pediatric nephrology centers,
constituting the largest pediatric SRNS cohort assembled to date. Results: In the
course of the project, traditional Sanger sequencing was replaced by NGS-based
gene panel screening covering over 30 podocyte-related genes complemented by
whole exome sequencing. These approaches allowed to establish genetic diagnoses
in 24% of the patients screened, widened the spectrum of genetic disease entities
presenting with SRNS phenotype (COL4A3-5, CLCN5), and contributed to the
discovery of new disease causing genes (MYOE1, PTPRO). Forty two percent of
patients responded to intensified immunosuppression with complete or partial
remission of proteinuria, whereas 58% turned out multi-drug resistant. Medication
responsiveness was highly predictive of a favorable long-term outcome, whereas
the diagnosis of genetic disease was associated with a high risk to develop
end-stage renal disease during childhood. Genetic SRNS forms were generally
resistant to immunosuppressive treatment, justifying to avoid such
pharmacotherapies altogether once a genetic diagnosis is established. Even
symptomatic anti-proteinuric treatment with RAS antagonists seems to be
challenging and of limited efficacy in genetic forms of SRNS. The risk of
post-transplant disease recurrence was around 30% in non-genetic SRNS whereas it
is negligible in genetic cases. Conclusion: In summary, the PodoNet Registry has
collected detailed clinical and genetic information in a large SRNS cohort and
continues to generate fundamental insights regarding demographic and etiological
disease aspects, genotype-phenotype associations, the efficacy of therapeutic
strategies, and long-term patient and renal outcomes including post-transplant
disease recurrence.