临床儿科杂志 ›› 2021, Vol. 39 ›› Issue (6): 433-.doi: 10.3969/j.issn.1000-3606.2021.06.008

• 综合报道 • 上一篇    下一篇

NPHP 不同基因变异进展为终末期肾病的肾单位肾痨3 例

徐鑫星, 孙周云, 邓凡, 沈芸妍, 徐勤英, 林强, 李晓忠   

  1. 苏州大学附属儿童医院肾脏免疫科(江苏苏州 215003)
  • 出版日期:2021-06-15 发布日期:2021-05-31
  • 通讯作者: 李晓忠 电子信箱:xiaozhonglicn@yeah.net
  • 基金资助:
    国家自然科学基金项目(No. 81370787)

Progressing of nephronophthisis with different NPHP gene variations to end-stage renal disease in 3 cases

Xinxing, SUN Zhouyun, DENG Fan, SHEN Yunyan, XU Qinying, LIN Qiang, LI Xiaozhong   

  1. Department of Nephrology and Immune, Children's Hospital of Soochow University, Suzhou 215003 , Jiangsu, China
  • Online:2021-06-15 Published:2021-05-31

摘要: 目的 分析不同NPHP变异导致肾单位肾痨的临床特征。方法 回顾分析3例NPHP变异致肾单位肾痨患儿 的临床资料。结果 3例患儿均为女性,且均有贫血表现。例1存在内脏反位、肝功能异常等肾外表现;例2、例3的肾脏病 理均示肾小球纤维化,肾小管基底膜完整性破坏,小管萎缩,肾脏间质炎症细胞浸润。例1、例2家族中有肾脏病史患者, 例3弟弟有相同基因变异,暂无表现。基因检测显示3例患儿均存在NPHP基因变异。例1在NEK8/NPHP9基因存在c.388A>C p.K 130 Q杂合变异以及c. 1465 G>A,p.V 489 M杂合变异,均为新发现的变异;例2为NPHP 1全基因缺失;例3的NPHP 3 基因存在c.3218T>G,p.L1073*纯合变异,其弟弟存在相同的纯合变异位点。3例患儿均已行肾脏移植治疗,门诊随访中。 结论 肾单位肾痨是一类临床和遗传异质性疾病,临床表现无特异性,基因检测有助于诊断。肾移植是NPHP进展为终 末期肾病的有效治疗手段。c. 388 A>C p.K 130 Q杂合错义变异和c. 1465 G>A,p.V 489 M杂合变异是新发现的NPHP基因 变异。

关键词: NPHP变异; 终末期肾病; 肾单位肾痨; 肾移植

Abstract: Objective To explore the clinical characteristics of nephronophthisis caused by different NPHP gene variations. Methods The clinical data of nephronophthisis caused by different NPHP gene variations in 3 children were retrospectively analyzed. Results All of the 3 cases were female and had manifestations of anemia. Case 1 had extrarenal manifestations such as visceral inversion and abnormal liver function. Renal pathology of case 2 and 3 showed glomerular fibrosis, destruction of the integrity of the tubular basement membrane, tubule atrophy and infiltration of inflammatory cells in the renal interstitium. Case 1 and 2 had a family history of kidney disease. The younger brother of case 3 carried the same variation but did not have any clinical manifestations. NPHP gene variations were identified in all 3 cases by genetic testing. In case 1 , there were heterozygous variants of c. 388 A>C p.K 130 Q and c. 1465 G>A, p.V 489 M in NEK 8 /NPHP 9 gene, both of which were newly discovered. Case 2 had whole deletion of NPHP 1 gene. In case 3 , there was a homozygous variation of c.3218 T>G, p.L1073 * in NPHP3 gene, and the same homozygous variation site was found in her younger brother. All 3 patients had received renal transplantation and were under follow-up. Conclusions Nephronophthisis is a kind of clinical and genetic heterogeneous disease with no specific clinical manifestations, and genetic testing is helpful for diagnosis. Renal transplantation is an effective treatment for the progression from nephronophthisis to end-stage renal disease. The heterozygous missense variation of c.388A>C p.K 130 Q and the heterozygous variation of c.1465 G>A, p.V 489 M are newly discovered NPHP gene variants

Key words: NPHP gene variation; end-stage renal disease; nephronophthisis; renal transplantation