Alport Syndrome - A rare presentation
Autor(a) principal: | |
---|---|
Data de Publicação: | 2017 |
Outros Autores: | , , , , |
Tipo de documento: | Relatório |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400009 |
Resumo: | Introduction: Alport syndrome is a glomerular genetic disease progressing to chronic renal failure associated with deafness and ocular changes. Clinical presentation is usually in the first decade of life with microscopic haematuria and/or persistent proteinuria without hypertension or renal dysfunction. Case Report: Male, 4.5 years old, with an acute nephritic syndrome characterized by macroscopic haematuria, oedema, non-oliguric acute renal failure (maximal urea and creatinine of 25mmol/L and 150μmol/L, respectively), anaemia and proteinuria. Blood pressure normal. Normal immunoglobulins and complement fractions; anti-neutrophil cytoplasmic antibody, anti-nuclear antibody and anti-basal membrane antibody negative. History of recurrent episodes of macroscopic haematuria since the age of eighteen months associated with respiratory infections. No family history of renal disease or deafness. Renal biopsy showed proliferative glomerulonephritis with extracapillary crescentic activity, complete fragmentation of glomerular basement membranes and negative immunofluorescence. Pulse methylprednisolone was given followed by oral prednisolone and cyclophosphamide. Renal function recovered, microscopic haematuria persisted. At age 5, there was reappearance of proteinuria, worsening progressively and two years later he started treatment with enalapril. At age 11, a second renal biopsy revealed mesangial proliferative glomerulonephritis, small foci of glomerular sclerosis and few deposits of IgM on immunofluorescence. He started oral corticosteroids with partial response. Nine months later, bilateral sensorineural deafness was detected. At age 16, he maintains normal renal function, microscopic haematuria with manifest proteinuria. A mutation in homozygosity in the COL4A3 gene, compatible with autosomal recessive Alport syndrome, was identified. Conclusions: This case draws attention to an uncommon early course and clinical/pathological findings of a patient later diagnosed with Alport syndrome, with an initial good response to corticosteroids and cyclophosphamide. The case also illustrates the importance of kidney biopsy, including electron microscopy, in the diagnostic, classification and therapy in kidney diseases with unusual clinical course |
id |
RCAP_1b2ebdbbb410c863999de7d65f8cde50 |
---|---|
oai_identifier_str |
oai:scielo:S0872-01692017000400009 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Alport Syndrome - A rare presentationAcute renal failureAlport syndromeCrescentic glomerulonephritisHaematuriaImmunosuppressionProteinuriaIntroduction: Alport syndrome is a glomerular genetic disease progressing to chronic renal failure associated with deafness and ocular changes. Clinical presentation is usually in the first decade of life with microscopic haematuria and/or persistent proteinuria without hypertension or renal dysfunction. Case Report: Male, 4.5 years old, with an acute nephritic syndrome characterized by macroscopic haematuria, oedema, non-oliguric acute renal failure (maximal urea and creatinine of 25mmol/L and 150μmol/L, respectively), anaemia and proteinuria. Blood pressure normal. Normal immunoglobulins and complement fractions; anti-neutrophil cytoplasmic antibody, anti-nuclear antibody and anti-basal membrane antibody negative. History of recurrent episodes of macroscopic haematuria since the age of eighteen months associated with respiratory infections. No family history of renal disease or deafness. Renal biopsy showed proliferative glomerulonephritis with extracapillary crescentic activity, complete fragmentation of glomerular basement membranes and negative immunofluorescence. Pulse methylprednisolone was given followed by oral prednisolone and cyclophosphamide. Renal function recovered, microscopic haematuria persisted. At age 5, there was reappearance of proteinuria, worsening progressively and two years later he started treatment with enalapril. At age 11, a second renal biopsy revealed mesangial proliferative glomerulonephritis, small foci of glomerular sclerosis and few deposits of IgM on immunofluorescence. He started oral corticosteroids with partial response. Nine months later, bilateral sensorineural deafness was detected. At age 16, he maintains normal renal function, microscopic haematuria with manifest proteinuria. A mutation in homozygosity in the COL4A3 gene, compatible with autosomal recessive Alport syndrome, was identified. Conclusions: This case draws attention to an uncommon early course and clinical/pathological findings of a patient later diagnosed with Alport syndrome, with an initial good response to corticosteroids and cyclophosphamide. The case also illustrates the importance of kidney biopsy, including electron microscopy, in the diagnostic, classification and therapy in kidney diseases with unusual clinical courseSociedade Portuguesa de Nefrologia2017-12-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/reporttext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400009Portuguese Journal of Nephrology & Hypertension v.31 n.4 2017reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400009Neves,CatarinaCordinhã,Ana CarolinaFerreira,CarmenSousa,VítorGomes,ClaraCorreia,António Jorgeinfo:eu-repo/semantics/openAccess2024-02-06T17:04:57Zoai:scielo:S0872-01692017000400009Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:18:59.434689Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Alport Syndrome - A rare presentation |
title |
Alport Syndrome - A rare presentation |
spellingShingle |
Alport Syndrome - A rare presentation Neves,Catarina Acute renal failure Alport syndrome Crescentic glomerulonephritis Haematuria Immunosuppression Proteinuria |
title_short |
Alport Syndrome - A rare presentation |
title_full |
Alport Syndrome - A rare presentation |
title_fullStr |
Alport Syndrome - A rare presentation |
title_full_unstemmed |
Alport Syndrome - A rare presentation |
title_sort |
Alport Syndrome - A rare presentation |
author |
Neves,Catarina |
author_facet |
Neves,Catarina Cordinhã,Ana Carolina Ferreira,Carmen Sousa,Vítor Gomes,Clara Correia,António Jorge |
author_role |
author |
author2 |
Cordinhã,Ana Carolina Ferreira,Carmen Sousa,Vítor Gomes,Clara Correia,António Jorge |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Neves,Catarina Cordinhã,Ana Carolina Ferreira,Carmen Sousa,Vítor Gomes,Clara Correia,António Jorge |
dc.subject.por.fl_str_mv |
Acute renal failure Alport syndrome Crescentic glomerulonephritis Haematuria Immunosuppression Proteinuria |
topic |
Acute renal failure Alport syndrome Crescentic glomerulonephritis Haematuria Immunosuppression Proteinuria |
description |
Introduction: Alport syndrome is a glomerular genetic disease progressing to chronic renal failure associated with deafness and ocular changes. Clinical presentation is usually in the first decade of life with microscopic haematuria and/or persistent proteinuria without hypertension or renal dysfunction. Case Report: Male, 4.5 years old, with an acute nephritic syndrome characterized by macroscopic haematuria, oedema, non-oliguric acute renal failure (maximal urea and creatinine of 25mmol/L and 150μmol/L, respectively), anaemia and proteinuria. Blood pressure normal. Normal immunoglobulins and complement fractions; anti-neutrophil cytoplasmic antibody, anti-nuclear antibody and anti-basal membrane antibody negative. History of recurrent episodes of macroscopic haematuria since the age of eighteen months associated with respiratory infections. No family history of renal disease or deafness. Renal biopsy showed proliferative glomerulonephritis with extracapillary crescentic activity, complete fragmentation of glomerular basement membranes and negative immunofluorescence. Pulse methylprednisolone was given followed by oral prednisolone and cyclophosphamide. Renal function recovered, microscopic haematuria persisted. At age 5, there was reappearance of proteinuria, worsening progressively and two years later he started treatment with enalapril. At age 11, a second renal biopsy revealed mesangial proliferative glomerulonephritis, small foci of glomerular sclerosis and few deposits of IgM on immunofluorescence. He started oral corticosteroids with partial response. Nine months later, bilateral sensorineural deafness was detected. At age 16, he maintains normal renal function, microscopic haematuria with manifest proteinuria. A mutation in homozygosity in the COL4A3 gene, compatible with autosomal recessive Alport syndrome, was identified. Conclusions: This case draws attention to an uncommon early course and clinical/pathological findings of a patient later diagnosed with Alport syndrome, with an initial good response to corticosteroids and cyclophosphamide. The case also illustrates the importance of kidney biopsy, including electron microscopy, in the diagnostic, classification and therapy in kidney diseases with unusual clinical course |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-12-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/report |
format |
report |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400009 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400009 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400009 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.31 n.4 2017 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799137279705350144 |