Tubulopathy

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Tubulopathy
Classification and external resources
ICD-10 N10-N16

Tubulopathy is a disease affecting the renal tubules of the nephron.[1]

Tubulopathic processes may be inflammatory or noninflammatory, though inflammatory processes are often referred to specifically as tubulitis.[2][3]


Characteristics of Some Inherited Tubulopathies[4]
Disorder [OMIM Number] Protein Defect Chromosome Localization Inheritance Clinical Features/Notes Biochemical Features
Proximal Tubule
Lowe's syndrome (oculocerebral dystrophy [309000] OCRL1 Xq26.1 XR Hydrophthalmia, cataract, mental retardation, hyporeflexia, hypotonia and progressive kidney failure, normotensive Plasma: ↓K, ↓CO2; Urine: ↑LMWP, ↑AA, ↑PO4, ↑K
Wilson's disease [277900] ATP7B 13q14.3-q21.1 AR Liver disease or neurologic symptoms, or both, Kayser-Fleischer rings, normotensive Plasma: ↑free copper, abnormal LFTs; Urine: ↑copper excretion, ↑LMWP, ↑AA, ↑PO4, ↑Glycosuria
Dent's disease (X-linked recessive hypophophatemic rickets)[300009] CLCN5 Xp11.22 XR Nephrocalcinosis, nephrolithiasis, rachitic and osteomalacic bone disease, progressive kidney failure, normotensive Plasma: ↓PO4, N/↓K; Urine: ↑LMWP, ↑AA, ↑K, ↑Ca, ↑PO4, ↑Glycosuria
X-linked dominant hypophosphatemic rickets [307800 PHEX Xp22.2-p22.1 XD Growth retardation, rachitic and osteomalacic bone disease, hypophosphatemia, and renal defects in phosphate reabsorption and vitamin D metabolism Plasma: ↓PO4, ↑ALP; Urine: ↑PO4
Loop of Henle
Bartter's syndrome NKCC2 (type 1) 15q15-21.1 AR Polyuria, polydipsia, muscle weakness, hypovolemia, normotensive or hypotensive (all types). Maternal polyhydramnios, premature birth, perinatal salt wasting, nephrocalcinosis and kidney stones (type 1 and 2), milder phenotype with normocalciuria(type 3), sensorineural deafness, motor retardation, renal failure (type 4) Plasma: ↑renin, ↓K, ↑CO2, mild ↓Mg in some patients; Urine: ↑Ca
[601678] ROMK (type 2) 11q24 AR
[241200] C1C-Kb (type 3, classic) 1p36 AR
[607364] 1p31 AR
[602522] Barttin (type 4)
Hypomagnesemic hypercalciuric nephrocalcinosis (magnesium-losing kidney)[248250] PCLN1 3q27 AR Nephrocalcinosis, renal failure, ocular/hearing defects, polyruria, polydipsia, recurrent urinary tract infections, recurrent renal colic, normotensive Plasma: ↓Mg, ↑PTH; Urine: ↑Ca, ↑Mg
Distal Tubule/Collecting Duct
Liddle's syndrome[177200] ENaC (activating) 16p13-p12 AD Early, and frequently severe, hypertension, stroke Plasma: ↓renin, ↓K, ↓Mg, ↑CO2; Urine: ↑K
Pseudohypoaldosteronism type 1a [264350] ENaC (inactivating) 12p13, 16p13-p12 AR Presents in infancy with salt-wasting and hypotension, Cough, respiratory infections Plasma: ↑renin, ↓Na, ↑K, ↓CO2; Urine: ↑K
Pseudohypoaldosteronism type 1b [177735] Mineralocorticoid receptor 4q31.1 AD Presents in infancy with salt-wasting and hypotension. Milder than type 1a and remits with age Plasma: ↑renin, ↓Na, ↑K, ↓CO2; Urine: ↑K
Pseudohypoaldosteronism type 2 (Gordon's syndrome) [145260] Unknown (?WNK) 1q31-q42, 12p13, 17q21-q22 AD Hypertension (± muscle weakness, short stature, intellectual impairment). Correction of physiologic abnormalities by thiazide diuretics Plasma: ↓renin, ↑K, ↓CO2, ↑Cl; Urine: ↓K
Gitelman's syndrome [263800] NCCT 16q13 AR Hypotension, weakness, paresthesias, tetany, fatigue, and salt craving, Presentation generally much later in life than in Bartter's and hypocalciuria is typical Plasma: ↑renin, ↓K, ↓Mg, ↑CO2; Urine: ↓calcium:creatinine excretion ratio (useful in distinguishing Gitelman's and Bartter's)(Note: biochemically can mimic thiazide use)
X-linked nephrogenic diabetes insipidus type 1 [304800] V2 receptor Xq28 XR Hyperthermia, polyuria, polydipsia, dehydration, inability to form concentrated urine, mental retardation if diagnosis delayed. Symptoms in infancy Hyperosmolar plasma, dilute urine
Autosomal dominant nephrogenic diabetes insipidus type 2 [192340] AQP2 12q13 AD and AR Polyuria, polydipsia, dehydration, inability to form concentrated urine. Symptoms after first year of life Hyperosmolar plasma, dilute urine

AA: Aminoaciduria; AD:autosomal dominant; AR: autosomal recessive; LFT's: Liver function tests; LMWP: low molecular weight proteinuria; XD: X-linked dominant; XR: X-linked recessive; PTH: Parathyroid hormone


References[edit]

  1. ^ "tubulopathy" at Dorland's Medical Dictionary
  2. ^ Ferrara P, D'Aleo CM, Rigante D, et al. (2003). "Amoxicillin-induced nephritis and tubulitis in a child". Urol. Int. 71 (1): 124–6. doi:10.1159/000071111. PMID 12845278. 
  3. ^ Robertson H, Wong WK, Talbot D, Burt AD, Kirby JA (January 2001). "Tubulitis after renal transplantation: demonstration of an association between CD103+ T cells, transforming growth factor beta1 expression and rejection grade". Transplantation 71 (2): 306–13. doi:10.1097/00007890-200101270-00024. PMID 11213078. 
  4. ^ Burtis, C.A.; Ashwood, E.R. and Bruns, D.E. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th Edition. Elsevier Saunders. p.1574-1575