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An international cohort study of autosomal dominant tubulointerstitial kidney disease due to REN mutations identifies distinct clinical subtypes

M. Živná, K. Kidd, M. Zaidan, P. Vyleťal, V. Barešová, K. Hodaňová, J. Sovová, H. Hartmannová, M. Votruba, H. Trešlová, I. Jedličková, J. Sikora, H. Hůlková, V. Robins, A. Hnízda, J. Živný, G. Papagregoriou, L. Mesnard, BB. Beck, A. Wenzel, K....

. 2020 ; 98 (6) : 1589-1604. [pub] 20200801

Language English Country United States

Document type Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.

Grant support
R01 DK119631 NIDDK NIH HHS - United States
R21 DK106584 NIDDK NIH HHS - United States
T32 DK007731 NIDDK NIH HHS - United States
NV17-29786A MZ0 CEP Register

There have been few clinical or scientific reports of autosomal dominant tubulointerstitial kidney disease due to REN mutations (ADTKD-REN), limiting characterization. To further study this, we formed an international cohort characterizing 111 individuals from 30 families with both clinical and laboratory findings. Sixty-nine individuals had a REN mutation in the signal peptide region (signal group), 27 in the prosegment (prosegment group), and 15 in the mature renin peptide (mature group). Signal group patients were most severely affected, presenting at a mean age of 19.7 years, with the prosegment group presenting at 22.4 years, and the mature group at 37 years. Anemia was present in childhood in 91% in the signal group, 69% prosegment, and none of the mature group. REN signal peptide mutations reduced hydrophobicity of the signal peptide, which is necessary for recognition and translocation across the endoplasmic reticulum, leading to aberrant delivery of preprorenin into the cytoplasm. REN mutations in the prosegment led to deposition of prorenin and renin in the endoplasmic reticulum-Golgi intermediate compartment and decreased prorenin secretion. Mutations in mature renin led to deposition of the mutant prorenin in the endoplasmic reticulum, similar to patients with ADTKD-UMOD, with a rate of progression to end stage kidney disease (63.6 years) that was significantly slower vs. the signal (53.1 years) and prosegment groups (50.8 years) (significant hazard ratio 0.367). Thus, clinical and laboratory studies revealed subtypes of ADTKD-REN that are pathophysiologically, diagnostically, and clinically distinct.

1st Department of Pediatrics Semmelweis University Budapest Hungary

AP HP CIC BT 504 Créteil France

AP HP Groupe Hospitalier Henri Mondor Albert Chenevier Créteil France

Center of Excellence in Biobanking and Biomedical Research Molecular Medicine Research Center University of Cyprus Nicosia Cyprus

Centre Hospitalier Universitaire de Toulouse Toulouse France

Département Biologie cellulaire INSERM U1151 Institut Necker Enfants Malades Paris France

Department of Biochemistry University of Cambridge Cambridge UK

Department of Experimental Diagnostic and Specialty Medicine Nephrology Dialysis and Renal Transplant Unit S Orsola Hospital University of Bologna Bologna Italy

Department of General Pediatrics Adolescent Medicine and Neonatology Medical Center Faculty of Medicine Universitätsklinikum Freiburg Freiburg Germany

Department of Medicine Division of Nephrology University of Arizona Health Sciences Center Tucson Arizona USA

Department of Nephrology and Renal Transplantation University Hospitals Leuven Leuven Belgium

Department of Nephrology Evangelismos Private Hospital Pafos Cyprus

Department of Nephrology‒Transplantation Necker Hospital APHP Paris France

Department of Pediatric Nephrology Medical University Wrocław Poland

Division of Nephrology and Dialysis Department of Medical and Surgical Specialties Radiological Sciences and Public Health University of Brescia and Montichiari Hospital Brescia Italy

Division of Nephrology Department of Medicine Duke University School of Medicine Durham North Carolina USA

Division of Nephrology Department of Pediatrics New York University School of Medicine New York New York USA

Division of Nephrology Department of Pediatrics Seattle Children's Hospital University of Washington Seattle Washington USA

Division of Nephrology Department of Pediatrics University of Florida Gainesville Florida USA

Division of Nephrology Indiana University School of Medicine Indianapolis Indiana USA

Division of Nephrology Ospedale Sant'Orsola‒Malpighi Bologna Italy

Duke Clinical Research Institute Durham North Carolina USA

Exeter Kidney Unit Royal Devon and Exeter NHS Foundation Trust Exeter Devon UK

France Rare Renal Disease Reference Centre Toulouse France

Institute of Pathophysiology 1st Faculty of Medicine Charles University Prague Czech Republic

Kidney Genetics Group Academic Nephrology Unit Department of Infection Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK

Laboratory of Human Molecular Genetics Faculty of Medicine University of Sfax Sfax Tunisia

Laboratory of Molecular and Cellular Immunology Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences Wrocław Poland

Laboratory of Nephrology Department of Microbiology and Immunology Katholieke Universiteit Leuven Leuven Belgium

Medical Genetics Department of Hedi Chaker Hospital Sfax Tunisia

Medical Genetics Unit Policlinico S Orsola Malpighi Bologna Italy

Molecular Genetics of Renal Disorders Division of Genetics and Cell Biology IRCCS San Raffaele Scientific Institute Milan Italy

MTA SE Lendület Nephrogenetic Laboratory Semmelweis University Budapest Hungary

Nephrology Division University of Montreal Hospital Centre Hopital Saint Luc Montréal Québec Canada

NIHR Newcastle Biomedical Research Centre Newcastle University Newcastle upon Tyne UK

Paris Descartes University Sorbonne Paris Cité Paris France

Pediatric Nephrology Centre Hospitalier Universitaire de Toulouse Toulouse France

Pediatric Nephrology University of Texas Southwestern Medical Center Dallas Texas USA

Pediatrics Nephrology Marshfield Medical Center Marshfield Wisconsin USA

Renal Services The Newcastle Hospitals NHS Foundation Trust Newcastle upon Tyne UK

Research Unit of Rare Diseases Department of Pediatric and Inherited Metabolic Disorders 1st Faculty of Medicine Charles University Prague Czech Republic

Section on Nephrology Wake Forest School of Medicine Winston Salem North Carolina USA

Service de Néphrologie‒Transplantation Hôpital de Bicêtre Le Kremlin Bicêtre France

Sorbonne Université Urgences Néphrologiques et Transplantation Rénale Assistance Publique Hôpitaux de Paris Hôpital Tenon Paris France

Translational and Clinical Research Institute Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK

Université Paris Est Créteil Equipe 21 INSERM U 955 Créteil France

University of Cologne Faculty of Medicine and University Hospital Cologne Center for Molecular Medicine Cologne Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Institute of Human Genetics Cologne Germany

References provided by Crossref.org

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$a An international cohort study of autosomal dominant tubulointerstitial kidney disease due to REN mutations identifies distinct clinical subtypes / $c M. Živná, K. Kidd, M. Zaidan, P. Vyleťal, V. Barešová, K. Hodaňová, J. Sovová, H. Hartmannová, M. Votruba, H. Trešlová, I. Jedličková, J. Sikora, H. Hůlková, V. Robins, A. Hnízda, J. Živný, G. Papagregoriou, L. Mesnard, BB. Beck, A. Wenzel, K. Tory, K. Häeffner, MTF. Wolf, ME. Bleyer, JA. Sayer, ACM. Ong, L. Balogh, A. Jakubowska, A. Łaszkiewicz, R. Clissold, C. Shaw-Smith, R. Munshi, RM. Haws, C. Izzi, I. Capelli, M. Santostefano, C. Graziano, F. Scolari, A. Sussman, H. Trachtman, S. Decramer, M. Matignon, P. Grimbert, LR. Shoemaker, C. Stavrou, M. Abdelwahed, N. Belghith, M. Sinclair, K. Claes, T. Kopel, S. Moe, C. Deltas, B. Knebelmann, L. Rampoldi, S. Kmoch, AJ. Bleyer
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$a There have been few clinical or scientific reports of autosomal dominant tubulointerstitial kidney disease due to REN mutations (ADTKD-REN), limiting characterization. To further study this, we formed an international cohort characterizing 111 individuals from 30 families with both clinical and laboratory findings. Sixty-nine individuals had a REN mutation in the signal peptide region (signal group), 27 in the prosegment (prosegment group), and 15 in the mature renin peptide (mature group). Signal group patients were most severely affected, presenting at a mean age of 19.7 years, with the prosegment group presenting at 22.4 years, and the mature group at 37 years. Anemia was present in childhood in 91% in the signal group, 69% prosegment, and none of the mature group. REN signal peptide mutations reduced hydrophobicity of the signal peptide, which is necessary for recognition and translocation across the endoplasmic reticulum, leading to aberrant delivery of preprorenin into the cytoplasm. REN mutations in the prosegment led to deposition of prorenin and renin in the endoplasmic reticulum-Golgi intermediate compartment and decreased prorenin secretion. Mutations in mature renin led to deposition of the mutant prorenin in the endoplasmic reticulum, similar to patients with ADTKD-UMOD, with a rate of progression to end stage kidney disease (63.6 years) that was significantly slower vs. the signal (53.1 years) and prosegment groups (50.8 years) (significant hazard ratio 0.367). Thus, clinical and laboratory studies revealed subtypes of ADTKD-REN that are pathophysiologically, diagnostically, and clinically distinct.
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