The Value of Genetic Testing in Polycystic Kidney Diseases Illustrated by a Family With PKD2 and COL4A1 Mutations

HALT Progression of Polycystic Kidney Disease Group Investigators

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

The diagnosis of autosomal dominant polycystic kidney disease (ADPKD) relies on imaging criteria in the setting of a positive familial history. Molecular analysis, seldom used in clinical practice, identifies a causative mutation in >90% of cases in the genes PKD1, PKD2, or rarely GANAB. We report the clinical and genetic dissection of a 7-generation pedigree, resulting in the diagnosis of 2 different cystic disorders. Using targeted next-generation sequencing of 65 candidate genes in a patient with an ADPKD-like phenotype who lacked the familial PKD2 mutation, we identified a COL4A1 mutation (p.Gln247*) and made the diagnosis of HANAC (hereditary angiopathy with nephropathy, aneurysms, and muscle cramps) syndrome. While 4 individuals had ADPKD-PKD2, various COL4A1-related phenotypes were identified in 5 patients, and 3 individuals with likely digenic PKD2/COL4A1 disease reached end-stage renal disease at around 50 years of age, significantly earlier than observed for either monogenic disorder. Thus, using targeted next-generation sequencing as part of the diagnostic approach in patients with cystic diseases provides differential diagnoses and identifies factors underlying disease variability. As specific therapies are rapidly developing for ADPKD, a precise etiologic diagnosis should be paramount for inclusion in therapeutic trials and optimal patient management.

Original languageEnglish (US)
Pages (from-to)302-308
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume72
Issue number2
DOIs
StatePublished - Aug 2018

Keywords

  • Autosomal dominant polycystic kidney disease (ADPKD)
  • COL4A1
  • HANAC
  • PKD2
  • case report
  • genetic testing
  • pedigree
  • phenotypic variability
  • targeted next-generation sequencing (TNGS)

ASJC Scopus subject areas

  • Nephrology

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