期刊
CLINICAL GENETICS
卷 103, 期 2, 页码 214-218出版社
WILEY
DOI: 10.1111/cge.14235
关键词
end-stage kidney disease; exome sequencing; genetics; molecular dynamics; renal Fanconi syndrome
This study discusses a case of a 10-year-old girl who presented with leg pain and elevated creatinine. Further investigations confirmed renal Fanconi syndrome (RFS) in the girl and identified a novel pathogenic variant in the GATM gene. The findings suggest the importance of screening the GATM gene in children with RFS, in addition to adults.
Renal Fanconi syndrome (RFS) is a generalised disorder of the proximal convoluted tubule. Many genes have been associated with RFS including those that cause systemic disorders such as cystinosis, as well as isolated RFS. We discuss the case of a 10-year-old female who presented with leg pain and raised creatinine on a screening blood test. Her mother has RFS and required a kidney transplant in her thirties. Further investigations confirmed RFS in the daughter. Exome sequencing was performed on the affected mother, child, and unaffected father. We identified a novel variant in GATM; c.965G>C p.(Arg322Pro) segregating dominantly in the mother and daughter. We validated our finding with molecular dynamics simulations and demonstrated a dynamic signature that differentiates our variant and two previously identified pathogenic variants in GATM from wildtype. Genetic testing has uncovered a novel pathogenic variant that predicts progression to end stage kidney failure and has important implications for family planning and cascade testing. We recommend that GATM is screened for in children presenting with RFS, in addition to adults, particularly with kidney failure, who may have had previous negative gene testing.
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