Expert Guidelines for the Management of Alport Syndrome and Thin Basement Membrane Nephropathy
TLDR
The recommendations include the use of genetic testing as the gold standard for the diagnosis of Alport syndrome and the demonstration of its mode of inheritance.Abstract:
Few prospective, randomized controlled clinical trials address the diagnosis and management of patientswith Alportsyndrome or thinbasement membrane nephropathy. Adult and pediatric nephrologists and geneticists from four continents whose clinical practice focuses on these conditions have developed the following guidelines. The 18recommendationsarebased onLevel D (Expert opinion withoutexplicitcritical appraisal,orbasedonphysiology, bench research, or first principles—NationalHealth Service category) or Level III (Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees—U.S. Preventive Services Task Force) evidence. The recommendations include the use of genetic testing as the gold standard for the diagnosis of Alport syndrome and the demonstrationofitsmodeofinheritance;theneedtoidentifyandfollowallaffectedmembersofa family with X-linked Alport syndrome, including most mothers of affected males; the treatment of males with X-linked Alport syndrome and individuals with autosomal recessive disease with renin-angiotensin system blockade, possibly even before the onset of proteinuria; discouraging the affected mothers of males with X-linked Alport syndrome from renal donation because of their own risk of kidney failure; and considerationofgenetictestingtoexcludeX-linkedAlportsyndromeinsomeindividualswith thin basement membrane nephropathy. The authors recognize that as evidence emerges, including data from patient registries, these guidelines will evolve further.read more
Citations
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Journal ArticleDOI
KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.
Krista L. Lentine,Bertram L. Kasiske,Andrew S. Levey,Patricia L. Adams,Josefina Alberú,Mohamed A. Bakr,Lorenzo Gallon,Catherine A. Garvey,S. Guleria,Philip Kam-Tao Li,Dorry L. Segev,Sandra J. Taler,Kazunari Tanabe,Linda Wright,Martin Zeier,Michael Cheung,Amit X. Garg +16 more
TL;DR: The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation, and proposed a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making.
Journal ArticleDOI
Anti-Glomerular Basement Membrane Disease.
TL;DR: The need for future work to further delineate the immunopathogenic mechanisms of anti-GBM disease, and how to better refine and improve treatments, is highlighted, particularly for patients presenting with adverse prognostic factors.
Journal ArticleDOI
Collagen (COL4A) mutations are the most frequent mutations underlying adult focal segmental glomerulosclerosis
Christine Gast,Reuben J. Pengelly,Matthew Lyon,David J. Bunyan,Eleanor G. Seaby,Nikki Graham,Gopalakrishnan Venkat-Raman,Sarah Ennis +7 more
TL;DR: It is shown that collagen IV mutations, including COL4A5, frequently underlie FSGS and should be considered, particularly with a positive family history, as well as in patients with a history of renal disease.
Journal ArticleDOI
Alport syndrome: a unified classification of genetic disorders of collagen IV α345: a position paper of the Alport Syndrome Classification Working Group.
Clifford E. Kashtan,Jie Ding,Guido Garosi,Laurence Heidet,Laura Massella,Koichi Nakanishi,Kandai Nozu,Alessandra Renieri,Michelle N. Rheault,Fang Wang,Oliver Gross +10 more
TL;DR: A new classification of genetic disorders of the collagen IV α345 molecule is proposed with the goal of improving renal outcomes through regular monitoring and early treatment.
Journal ArticleDOI
Ocular Features in Alport Syndrome: Pathogenesis and Clinical Significance
TL;DR: Lenticonus and central fleck retinopathy strongly suggest the diagnosis of Alport syndrome and are associated with renal failure before the age of 30 years, in males with X-linked disease.
References
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Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy
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Weekly clinicopathological exercises
Robert E. Scully,Eugene J. Mark,William F. McNeely,Jo-Anne O. Shepard,Sally H. Ebeling,Stacey M. Ellender,Christine C. Peters +6 more
Journal ArticleDOI
Alport's Syndrome, Goodpasture's Syndrome, and Type IV Collagen
TL;DR: In this article, the authors have shown that mutations in genes corresponding to the building blocks of type IV collagen cause Alport's syndrome, whereas autoantibodies against structures that are usually hidden in the recesses of collagen IV cause Goodpasture's syndrome.
Journal ArticleDOI
Identification of mutations in the COL4A5 collagen gene in Alport syndrome.
David F. Barker,Sirkka Liisa Hostikka,Jing Zhou,Louise T. Chow,Arnold R. Oliphant,Steven C. Gerken,Martin C. Gregory,Mark H. Skolnick,Curtis L. Atkin,Karl Tryggvason +9 more
TL;DR: Three structural aberrations were found in COL4A5, in intragenic deletion, a Pst I site variant, and an uncharacterized abnormality, which appear to cause nephritis and deafness, with allele-specific severity, in three Alport syndrome kindreds in Utah.
Journal ArticleDOI
Identification of Mutations in the Alpha-3(iv) and Alpha-4(iv) Collagen Genes in Autosomal Recessive Alport Syndrome
Toshio Mochizuki,Toshio Mochizuki,Henny H. Lemmink,Mariko Mariyama,Corinne Antignac,Marie-Claire Gubler,Yves Pirson,Christine Verellen-Dumoulin,Belinda Chan,Cornelis H. Schröder,Hubert J.M. Smeets,Stephen T. Reeders,Stephen T. Reeders +12 more
TL;DR: Alport syndrome is an hereditary disease of basement membranes characterized by progressive renal failure and deafness and there is an autosomal form of AS in addition to the previously-defined X-linked form, demonstrating that these chains are important in the structural integrity of the GBM.
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