Unexpectedly High Prevalence of Low Alpha-Galactosidase A Enzyme Activity in Patients with Focal Segmental Glomerulosclerosis

OBJECTIVES: Fabry disease (FD) is a rare disease associated with sphingolipid accumulation. Sphingolipids are components of plasma membranes that are important in podocyte function and accumulate in various glomerular diseases such as focal segmental glomerulosclerosis (FSGS). Both FD and FSGS can cause podocyte damage and are classified as podocytopathies. In this respect, FD and FSGS share the same pathophysiologic pathways. Previous screening studies have shown that a significant proportion of end-stage renal disease (ESRD) patients receiving hemodialysis (HD) have unsuspected FD, and the prevalence of low alpha-galactosidase A (aGLA) enzyme activity in these patients is higher than that in the normal population. We aimed to compare aGLA enzyme activity in patients with biopsy-proven FSGS and ESRD receiving HD. METHODS: The records of 232 patients [62 FSGS (F/M: 33/29); 170 HD (M/F: 93/79)] were evaluated retrospectively. The screening was performed based on the aGLA enzyme activity on a dried blood spot, with the confirmation of plasma LysoGb3 levels, and the known GLA mutations were tested in patients with low enzyme activities. The two groups were compared using these parameters. RESULTS: The mean level of aGLA enzyme activity was found to be lower in FSGS patients than in the HD group (2.88 +/- 1.2 mmol/L/h versus 3.79 +/- 1.9 mmol/L/h, po0.001). There was no significant relationship between the two groups with regard to the plasma LysoGb3 levels (2.2 +/- 1.22 ng/ml versus 1.7 +/- 0.66 ng/ml, p: 0.4). In the analysis of GLA mutations, a D313Y mutation [C(937G4T) in exon p] was found in one patient from the FSGS group. CONCLUSIONS: We found that aGAL activity in patients with FSGS is lower than that in patients undergoing HD. The low enzyme activity in patients with FSGS may be explained by considering the similar pathogenesis of FSGS and FD, which may also lead to sphingolipid deposition and podocyte injury.