NDT Advance Access originally published online on July 5, 2006
Nephrology Dialysis Transplantation 2006 21(9):2452-2463; doi:10.1093/ndt/gfl274
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
Phenotypic and genetic heterogeneity in Dent's disease—the results of an Italian collaborative study
1 Division of Nephrology, Department of Medical and Surgical Sciences, University of Padua, Padua, 2 Laboratory of Pathophysiology of Uremia, Pediatric Institute G. Gaslini, Genoa, 3 Division of Nephrology and Dialysis, Pediatric Hospital Bambin Gesù, Rome, 4 Division of Nephrology, Dialysis and Kidney Transplantation, Pediatric Institute G. Gaslini, Genoa, 5 Division of Nephrology, Dialysis and Hypertension, IRCCS San Raffaele Hospital, Milan, 6 Division of Nephrology, Camposampiero General Hospital, Camposampiero, 7 Division of Pediatrics and Neonatology, San Salvatore Hospital, Pesaro, 8 Pediatric Institute, University of Parma, Parma, 9 Division of Nephrology, Dialysis and Transplantation, Regina Margherita Hospital, Turin, 10 Department of Pediatrics, University of Padua, Padua, 11 Pediatric Institute, University of Ancona, Ancona and 12 Division of Nephrology, Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy
Correspondence and offprint requests to: Enrica Tosetto, PhD, Division of Nephrology, Department of Medical and Surgical Sciences, University of Padua, via Giustiniani, 2 35128 Padova, Italy. Email: enrica.tosetto{at}unipd.it
Background. Dent's disease is an inherited tubulopathy caused by CLCN5 gene mutations. While a typical phenotype characterized by low-molecular-weight (LMW) proteinuria, hypercalciuria, nephrocalcinosis, nephrolithiasis, rickets and progressive renal failure in various combinations often enables a clinical diagnosis, less severe sub-clinical cases may go under-diagnosed.
Methods. By single-strand conformation polymorphism analysis and direct sequencing, we screened 40 male patients from 40 unrelated families for CLCN5 gene mutations. Twenty-four of these patients had the prominent features of Dent's disease, including LMW proteinuria, hypercalciuria and nephrocalcinosis.
Results. We identified 24 mutations in the CLCN5 gene in 21/24 patients with a typical phenotype and in 3/16 patients with a partial clinical picture of Dent's disease. Overall, 10 novel CLCN5 mutations were identified (E6fsX11, W58fsX97, 267 del E, Y272C, N340K, F444fsX448, W547X, Q600X, IVS3 +2 G>C and IVS3 –1 G>A), extending the number of mutations identified so far from 75 to 85. The CLCN5 coding sequence was normal in three patients. In the group with an incomplete Dent's disease phenotype, we detected two intronic mutations and one silent substitution leading to the up regulation of an alternatively spliced isoform.
Conclusions. Our data confirm the genetic heterogeneity of Dent's disease. In most classic cases, the clinical diagnosis is confirmed by genetic tests.
Keywords: CLCN5 gene mutations; Dent's disease; exonic splicing enhancer; genotype–phenotype correlation; splicing mutation