Polycystic kidney disease without an apparent family history

Ioan Andrei Iliuta, Vinusha Kalatharan, Kairong Wang, Emilie Cornec Le Gall, John Conklin, Marina Pourafkari, Ryan Ting, Chen Chen, Alessia C. Borgo, Ning He, Xuewen Song, Christina M. Heyer, Sarah R. Senum, Young Hwan Hwang, Andrew D. Paterson, Peter C Harris, Korosh Khalili, York Pei

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

The absence of a positive family history (PFH) in10%-25%of patients poses a diagnostic challenge for autosomal dominant polycystic kidney disease (ADPKD). In the Toronto Genetic Epidemiology Study of Polycystic Kidney Disease, 210 affected probands underwent renal function testing, abdominal imaging, and comprehensive PKD1 and PKD2 mutation screening. From this cohort, we reviewed all patients with and without an apparent family history, examined their parental medical records, and performed renal imaging in all available parents of unknown disease status. Subsequent reclassification of 209 analyzed patients revealed 72.2%(151 of 209) with a PFH, 15.3% (32 of 209) with de novo disease, 10.5% (22 of 209) with an indeterminate family history, and 1.9% (four of 209) with PFH in retrospect. Among the patients with de novo cases, we found two families with germline mosaicism and one family with somatic mosaicism. Additionally, analysis of renal imaging revealed that 16.3% (34 of 209) of patients displayed atypical PKD, most of which followed one of three patterns: asymmetric or focal PKD with PFH and an identified PKD1 or PKD2 mutation (15 of 34), asymmetric and de novo PKD with proven or suspected somatic mosaicism (seven of 34), or focal PKD without any identifiable PKD1 or PKD2 mutation (eight of 34). In conclusion, PKD without an apparent family history may be due to de novo disease, missing parental medical records, germline or somatic mosaicism, or mild disease from hypomorphic PKD1 and PKD2mutations. Furthermore, mutations of a newly identified gene for ADPKD,GANAB, and somatic mosaicism need to be considered in the mutation-negative patients with focal disease.

Original languageEnglish (US)
Pages (from-to)2768-2776
Number of pages9
JournalJournal of the American Society of Nephrology
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2017

ASJC Scopus subject areas

  • Nephrology

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    Iliuta, I. A., Kalatharan, V., Wang, K., Gall, E. C. L., Conklin, J., Pourafkari, M., Ting, R., Chen, C., Borgo, A. C., He, N., Song, X., Heyer, C. M., Senum, S. R., Hwang, Y. H., Paterson, A. D., Harris, P. C., Khalili, K., & Pei, Y. (2017). Polycystic kidney disease without an apparent family history. Journal of the American Society of Nephrology, 28(9), 2768-2776. https://doi.org/10.1681/ASN.2016090938