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Erschienen in: Clinical and Experimental Nephrology 5/2009

01.10.2009 | Case Report

Hemolytic uremic syndrome due to homozygous factor H deficiency

verfasst von: Sidharth Kumar Sethi, Dragon-Durey Marie-Agnes, Neelam Thaker, Pankaj Hari, Arvind Bagga

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 5/2009

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Abstract

The majority of complement factor H mutations associated with atypical hemolytic uremic syndrome (HUS) are heterozygous. Homozygous mutations causing atypical hemolytic uremic syndrome are rare. We report a 7-month-old boy with HUS, severe hypocomplementemia (low C3 and normal C4 levels), and extremely low circulating levels of factor H. Genetic analysis showed homozygous 4 bp deletion in the gene encoding factor H in the patient, with his parents being carriers. The patient showed progression to end-stage renal disease and is presently on chronic ambulatory peritoneal dialysis.
Literatur
1.
Zurück zum Zitat Taylor CM. Complement factor H and the haemolytic uraemic syndrome. Lancet. 2001;358:1200–2.CrossRefPubMed Taylor CM. Complement factor H and the haemolytic uraemic syndrome. Lancet. 2001;358:1200–2.CrossRefPubMed
2.
Zurück zum Zitat Noris M, Ruggenenti P, Perna A, Orisio S, Caprioli J, Skerka C, et al. Hypocomplementemia discloses genetic predisposition to hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: role of factor H abnormalities. Italian Registry of Familial and Recurrent Hemolytic Uremic Syndrome/Thrombotic Thrombocytopenic Purpura. J Am Soc Nephrol. 1999;10:281–93.PubMed Noris M, Ruggenenti P, Perna A, Orisio S, Caprioli J, Skerka C, et al. Hypocomplementemia discloses genetic predisposition to hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: role of factor H abnormalities. Italian Registry of Familial and Recurrent Hemolytic Uremic Syndrome/Thrombotic Thrombocytopenic Purpura. J Am Soc Nephrol. 1999;10:281–93.PubMed
3.
Zurück zum Zitat Caprioli J, Noris M, Brioschi S, Pianetti G, Castelletti F, Bettinaglio P, et al. International Registry of Recurrent and Familial HUS/TTP; Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood. 2006;108:1267–79.CrossRefPubMedPubMedCentral Caprioli J, Noris M, Brioschi S, Pianetti G, Castelletti F, Bettinaglio P, et al. International Registry of Recurrent and Familial HUS/TTP; Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood. 2006;108:1267–79.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Dragon-Durey MA, Frémeaux-Bacchi V, Loirat C, Blouin J, Niaudet P, Deschenes G, et al. Heterozygous and homozygous factor H deficiencies associated with hemolytic uremic syndrome or membranoproliferative glomerulonephritis: report and genetic analysis of 16 cases. J Am Soc Nephrol. 2004;15:787–95.CrossRefPubMed Dragon-Durey MA, Frémeaux-Bacchi V, Loirat C, Blouin J, Niaudet P, Deschenes G, et al. Heterozygous and homozygous factor H deficiencies associated with hemolytic uremic syndrome or membranoproliferative glomerulonephritis: report and genetic analysis of 16 cases. J Am Soc Nephrol. 2004;15:787–95.CrossRefPubMed
5.
Zurück zum Zitat Pichette V, Quérin S, Schürch W, Brun G, Lehner-Netsch G, Delâge J. Familial hemolytic–uremic syndrome and homozygous factor H deficiency. Am J Kidney Dis. 1994;24:936–41.CrossRefPubMed Pichette V, Quérin S, Schürch W, Brun G, Lehner-Netsch G, Delâge J. Familial hemolytic–uremic syndrome and homozygous factor H deficiency. Am J Kidney Dis. 1994;24:936–41.CrossRefPubMed
6.
Zurück zum Zitat Ohali M, Shalev H, Schlesinger M, Katz Y, Kachko L, Carmi R, et al. Hypocomplementemic autosomal recessive hemolytic uremic syndrome with decreased factor H. Pediat Nephrol. 1998;12:619–24.CrossRefPubMed Ohali M, Shalev H, Schlesinger M, Katz Y, Kachko L, Carmi R, et al. Hypocomplementemic autosomal recessive hemolytic uremic syndrome with decreased factor H. Pediat Nephrol. 1998;12:619–24.CrossRefPubMed
7.
Zurück zum Zitat Kazatchkine MD, Hauptmann G, Nydegger U: Techniques de Complément, Paris, Société Française d’Immunologie 1985. Kazatchkine MD, Hauptmann G, Nydegger U: Techniques de Complément, Paris, Société Française d’Immunologie 1985.
8.
Zurück zum Zitat Kazatchkine MD, Fearon DT, Austen KF. Human alternative complement pathway: membrane-associated sialic acid regulates the competition between B and β1 H for cell-bound C3b. J Immunol. 1979;122:75–81.PubMed Kazatchkine MD, Fearon DT, Austen KF. Human alternative complement pathway: membrane-associated sialic acid regulates the competition between B and β1 H for cell-bound C3b. J Immunol. 1979;122:75–81.PubMed
10.
Zurück zum Zitat Vaziri-Sani F, Holmberg L, Sjöholm AG, Kristoffersson AC, Manea M, Frémeaux-Bacchi V, et al. Phenotypic expression of factor H mutations in patients with atypical hemolytic uremic syndrome. Kidney Int. 2006;69:981–8.CrossRefPubMed Vaziri-Sani F, Holmberg L, Sjöholm AG, Kristoffersson AC, Manea M, Frémeaux-Bacchi V, et al. Phenotypic expression of factor H mutations in patients with atypical hemolytic uremic syndrome. Kidney Int. 2006;69:981–8.CrossRefPubMed
11.
Zurück zum Zitat Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA, Macher MA, Niaudet P, Guest G, et al. French Society of Pediatric Nephrology; differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2007;18:2392–400.CrossRefPubMed Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA, Macher MA, Niaudet P, Guest G, et al. French Society of Pediatric Nephrology; differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2007;18:2392–400.CrossRefPubMed
12.
Zurück zum Zitat Schmidt BZ, Fowler NL, Hidvegi T, Perlmutter DH, Colten HR. Disruption of disulfide bonds is responsible for impaired secretion in human complement factor H deficiency. J Biol Chem. 1999;274:11782–8.CrossRefPubMed Schmidt BZ, Fowler NL, Hidvegi T, Perlmutter DH, Colten HR. Disruption of disulfide bonds is responsible for impaired secretion in human complement factor H deficiency. J Biol Chem. 1999;274:11782–8.CrossRefPubMed
13.
Zurück zum Zitat Ault BH, Schmidt BZ, Fowler NL, Kashtan CE, Ahmed AE, Vogt BA, et al. Human factor H deficiency. Mutations in framework cysteine residues and block in H protein secretion and intracellular catabolism. J Biol Chem. 1997;272:25168–75.CrossRefPubMed Ault BH, Schmidt BZ, Fowler NL, Kashtan CE, Ahmed AE, Vogt BA, et al. Human factor H deficiency. Mutations in framework cysteine residues and block in H protein secretion and intracellular catabolism. J Biol Chem. 1997;272:25168–75.CrossRefPubMed
14.
Zurück zum Zitat Edey MM, Mead PA, Saunders RE, Strain L, Perkins SJ, Goodship TH, et al. Association of a factor H mutation with hemolytic uremic syndrome following a diarrheal illness. Am J Kidney Dis. 2008;51:487–90.CrossRefPubMed Edey MM, Mead PA, Saunders RE, Strain L, Perkins SJ, Goodship TH, et al. Association of a factor H mutation with hemolytic uremic syndrome following a diarrheal illness. Am J Kidney Dis. 2008;51:487–90.CrossRefPubMed
15.
Zurück zum Zitat Allford SL, Hunt BJ, Rose P, Machin SJ. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol. 2003;120:556–73.CrossRefPubMed Allford SL, Hunt BJ, Rose P, Machin SJ. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol. 2003;120:556–73.CrossRefPubMed
16.
Zurück zum Zitat Saland JM, Emre SH, Shneider BL, Benchimol C, Ames S, Bromberg JS, et al. Favorable long-term outcome after liver–kidney transplant for recurrent hemolytic uremic syndrome associated with a factor H mutation. Am J Transplant. 2006;6:1948–52.CrossRefPubMed Saland JM, Emre SH, Shneider BL, Benchimol C, Ames S, Bromberg JS, et al. Favorable long-term outcome after liver–kidney transplant for recurrent hemolytic uremic syndrome associated with a factor H mutation. Am J Transplant. 2006;6:1948–52.CrossRefPubMed
17.
Zurück zum Zitat Jalanko H, Peltonen S, Koskinen A, Puntila J, Isoniemi H, Holmberg C, et al. Successful liver–kidney transplantation in two children with aHUS caused by a mutation in complement factor H. Am J Transplant. 2008;8:216–21.PubMed Jalanko H, Peltonen S, Koskinen A, Puntila J, Isoniemi H, Holmberg C, et al. Successful liver–kidney transplantation in two children with aHUS caused by a mutation in complement factor H. Am J Transplant. 2008;8:216–21.PubMed
18.
Zurück zum Zitat Thompson RA, Winterborn MH. Hypocomplementaemia due to a genetic deficiency of beta 1H globulin. Clin Exp Immunol. 1981;46:110–9.PubMedPubMedCentral Thompson RA, Winterborn MH. Hypocomplementaemia due to a genetic deficiency of beta 1H globulin. Clin Exp Immunol. 1981;46:110–9.PubMedPubMedCentral
19.
Zurück zum Zitat Landau D, Shalev H, Levy-Finer G, Polonsky A, Segev Y, Katchko L. Familial hemolytic uremic syndrome associated with complement factor H deficiency. J Pediatr. 2001;138:412–7.CrossRefPubMed Landau D, Shalev H, Levy-Finer G, Polonsky A, Segev Y, Katchko L. Familial hemolytic uremic syndrome associated with complement factor H deficiency. J Pediatr. 2001;138:412–7.CrossRefPubMed
20.
Zurück zum Zitat Caprioli J, Bettinaglio P, Zipfel PF, Amadei B, Daina E, Gamba S, et al. Italian Registry of Familial and Recurrent HUS/TTP; The molecular basis of familial hemolytic uremic syndrome: mutation analysis of factor H gene reveals a hot spot in short consensus repeat 20. J Am Soc Nephrol. 2001;12:297–307.PubMed Caprioli J, Bettinaglio P, Zipfel PF, Amadei B, Daina E, Gamba S, et al. Italian Registry of Familial and Recurrent HUS/TTP; The molecular basis of familial hemolytic uremic syndrome: mutation analysis of factor H gene reveals a hot spot in short consensus repeat 20. J Am Soc Nephrol. 2001;12:297–307.PubMed
21.
Zurück zum Zitat Cho HY, Lee BS, Moon KC, Ha IS, Cheong HI, Choi Y. Complete factor H deficiency-associated atypical hemolytic uremic syndrome in a neonate. Pediatr Nephrol. 2007;22:874–80.CrossRefPubMed Cho HY, Lee BS, Moon KC, Ha IS, Cheong HI, Choi Y. Complete factor H deficiency-associated atypical hemolytic uremic syndrome in a neonate. Pediatr Nephrol. 2007;22:874–80.CrossRefPubMed
Metadaten
Titel
Hemolytic uremic syndrome due to homozygous factor H deficiency
verfasst von
Sidharth Kumar Sethi
Dragon-Durey Marie-Agnes
Neelam Thaker
Pankaj Hari
Arvind Bagga
Publikationsdatum
01.10.2009
Verlag
Springer Japan
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 5/2009
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-009-0205-3

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