Clinical and pathohistological characteristics of Alport spectrum disorder caused by COL4A4 mutation c.193-2A>C: a case series

Abstract

Aim To present the pathohistological and clinical characteristics of five Croatian families with Alport spectrum disorders caused by splice acceptor pathogenic variant c.193-2A>C in COL4A4 at the genomic position chr2:227985866. Methods The study enrolled five probands with kidney biopsy analysis and five family members. Mutation screening was performed with Illumina MiSeq platform. The pathogenic variant was confirmed with standard dye-terminator sequencing. Results The only homozygous patient, aged two, had proteinuria and hematuria with preserved kidney function and no extrarenal manifestations. This patient had changes characteristic for Alport syndrome observed on electron microscopy of the kidney biopsy. In the heterozygous group, six patients had hematuria, four biopsied probands had proteinuria, and only one had moderately reduced kidney function. Heterozygous probands had variable kidney biopsy findings. Three patients had thin glomerular basement membrane nephropathy visible on electron microscopy and focal segmental glomerulosclerosis on light microscopy, two of them with focal lamellation on electron microscopy. One heterozygous patient had changes characteristic for Alport syndrome on electron microscopy without focal segmental glomerulosclerosis. Conclusion The homozygous patient had hematuria and proteinuria with preserved kidney function. The heterozygous patients presented with reasonably mild clinical phenotype and variable pathohistological findings.

Clinical and histopathological characteristics of COL4A3 c.2881+1G>A variant causing Alport spectrum disorders in Croatian population

“…In our cohort, this variability was present both in clinical and histopathological findings, especially among members of family D ( Tables 2 and 3 ). We have previously described similar clinical and histopathological variability in the pathogenic variant COL4A4 c.193-2A> C [ 51 ].…”

Clinicopathological Features of Hereditary Nephritis in the Iranian Population: Analysis of a 14-Year Survey in Kidney Biopsies From a Large Referral Center

“…3,4 Unlike X-linked cases, which mostly lead to end-stage renal disease (ESRD) in men, autosomal cases can cause a variety of symptoms, ranging from hematuria to ESRD in men or women. 5,6 TBMN, also known as benign familial hematuria, affects about 1% of the general population. [7][8][9] Approximately 50% of patients with TBMN present as an autosomal dominant pattern, and 40-50% as mutations in the COL4A3 or COL4A4 genes on the X chromosome.…”

“… 3 , 4 Unlike X-linked cases, which mostly lead to end-stage renal disease (ESRD) in men, autosomal cases can cause a variety of symptoms, ranging from hematuria to ESRD in men or women. 5 , 6 …”