Genomic and clinical profiling of a national Nephrotic Syndrome cohort advocates a precision medicine approach to disease management

Agnieszka Bierzynska, Hugh McCarthy, Katrina Soderquest, Ethan Sen, Elizabeth Colby, Wen Ding, Marwa Nabhan, Larissa Kerecuk, Gavin Welsh, Moin Saleem, Shivram Hedge, David Hughes, Stephen Marks, Sally Feather, Caroline Jones, Nicholas J A Webb, Milos Ognjanovic, Martin Christian, Rodney D Gilbert, Manish SinhaGraham M. Lord, Michael A Simpson, Ania Koziell

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Steroid Resistant Nephrotic Syndrome (SRNS) in children and young adults has differing aetiologies with monogenic disease accounting for 2.9-30% in selected series.
We aimed, using whole exome sequencing, to stratify a national population of SRNS children into monogenic and non-monogenic forms, and further define those groups by detailed phenotypic analysis
Paedatric SRNS patients were collected via a national UK Renal Registry (RaDaR). Whole exome sequencing (WES) was performed on 187 patients, of which 12% had a positive family history. Analysis focused on the 53 genes currently known to be associated with NS. Genetic findings were correlated with individual case disease characteristics.
Disease causing variants were detected in 26.2% of patients. Most occurred in the three most commonly SRNS associated genes: NPHS1, NPHS2 and WT1 but also in 14 other genes. Genotype did not always correlate with expected phenotype, e.g. mutations in OCRL, COL4A3 and DGKE, associated with specific syndromes, were detected in isolated renal disease. Analysis by primary/presumed vs. secondary steroid resistance revealed 30.8% monogenic disease in primary compared to 0% in secondary SRNS permitting further mechanistic stratification. Genetic SRNS progressed faster to end stage renal failure, with no documented disease recurrence post-transplantation within this cohort. Primary steroid resistance in which no gene mutation was identified had a 47.8% risk of recurrence
In this unbiased paediatric population, WES allowed screening of all current candidate genes. Together with deep phenotyping we propose that this is an effective tool for early identification of SRNS aetiology, yielding an evidence-based algorithm for clinical management.
Original languageEnglish
Pages (from-to)937–947
Number of pages11
JournalKidney International
Volume91
Issue number4
Early online date20 Jan 2017
DOIs
Publication statusPublished - 1 Apr 2017

Keywords

  • Cytoskeleton
  • Focal Segmental Glomerulosclerosis
  • nephrotic syndrome
  • paediatric nephrology
  • podocyte
  • proteinuria

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