Introduction
Monogenetic condition | Inheritance pattern | Gene affected (MIM number) | Clinical features | Diagnostic implication and steps towards precision medicine |
---|---|---|---|---|
Infantile hypercalcaemia | Autosomal recessive; incomplete autosomal dominant | CYP24A1 (126065) | Hypercalcaemia, elevated 1,25 (OH)2D, suppressed PTH, nephrolithiasis, nephrocalcinosis | Restrict excess vitamin D, avoid sun exposure and tanning beds Fluconazole treatment Rifampin treatment |
Hypophosphataemic nephrolithiasis with osteoporosis | Autosomal dominant | SLC34A1 (612286) | Renal phosphate wasting, nephrolithiasis | Familial screening Bone densitometry |
Hypophosphataemic rickets with hypercalciuria | Autosomal recessive | SLC34A3 (241530) | Hypophosphataemia Elevated 1,25 (OH)2D | Phosphate supplement Restrict Vitamin D |
Autosomal-dominant hypocalcaemic hypercalciuria | Autosomal dominant | CASR (601198) | Basal ganglia calcifications, seizures, cramps, tetany nephrolithiasis | Familial screening, judicious calcium replacement, thiazide diuretics |
Distal renal tubular acidosis | Autosomal dominant (and recessive) | SLC4A1 (109270) | Acidosis, hypokalaemia. Growth impairment, nephrocalcinosis, nephrolithiasis. Haemolytic anaemia, spherocytosis/elliptocytosis | Bicarbonate and potassium replacement, familial screening. Monitor for CKD |
Distal renal tubular acidosis | Autosomal recessive | ATP6V1B1 (267300) ATP6V0A4 (602722) FOXI1 (601093) | Acidosis, sensorineural hearing loss, rickets, osteomalacia | Bicarbonate and potassium replacement, familial screening Referral for audiometry Monitor for CKD |
Cystinuria | Autosomal recessive and autosomal dominant with incomplete penetrance | SLC3A1 (104614) SLC7A9 (604144) | Elevated urine cysteine Recurrent stones—cysteine ± calcium stones, obstructive uropathy, pyelonephritis, chronic kidney disease | Family screening, urine alkalinisation, cysteine binding drugs, low animal protein diet, low sodium diet Stones may be resistant to shock wave lithotripsy Monitor for CKD |
Xanthine oxidase deficiency (xanthinuria) | Autosomal recessive | XDH (278300) | Xanthine stones, low uric acid, myopathy | Avoid high purine foods Hydration Radiolucent stones |
Primary hyperoxaluria type 1 | Autosomal recessive | AGXT (604285) | Urinary oxalate raised, calcium oxalate stones, nephrocalcinosis, ESRD | Pyridoxine therapy (for certain mutations) Liver transplantation to prevent disease recurrence Monitor for CKD |
Primary hyperoxaluria type 2 | Autosomal recessive | GRHPR (260000) | Urinary oxalate raised, calcium oxalate stones, nephrocalcinosis, ESRD | Monitor for CKD |
Primary hyperoxaluria type 3 | Autosomal recessive | HOGA1 (613597) | Urinary oxalate raised, calcium oxalate stones | Limit hydroxyproline intake |
Adenine phosphoribosyltransferase deficiency | Autosomal recessive | APRT (614723) | Excess urinary 2,8-dihydroxyadenine (DHA) 2,8-DHA kidney stones Intratubular and interstitial precipitation of DHA crystals leading to chronic kidney disease, ESRD | Allopurinol (xanthine dehydrogenase inhibitor) can prevent and dissolve kidney stones and improve kidney function Purine restriction Radiolucent stones Beware ESRD of unknown cause, may recur in renal transplant |
Hypophosphataemic rickets with hypercalciuria | Autosomal recessive | SLC34A3 (241530) | Hypophosphataemia Elevated 1,25 (OH)2D | Phosphate supplement Restrict Vitamin D |
Familial hypomagnesaemia with hypercalciuria and nephrocalcinosis | Autosomal recessive | CLDN16 (248250) | Myopia, hypercalciuria, nephrocalcinosis and nephrolithiasis ESRD may occur in second and third decade of life | Difficult to treat Thiazides may be tried Familial screening Monitor for CKD |
Phosphoribosyl pyrophosphate synthase (PRPPS) hyperactivity | X-linked recessive | PRPS1 (311850) | Hyperuricaemia, uric acid stones | Allopurinol (xanthine dehydrogenase inhibitor) Purine restriction |
Dent’s disease type 1 and 2 (Lowe syndrome) | X-linked recessive | CLCN5 (300008) OCRL (300535) | Low molecular weight proteinuria Hypercalciuria, Nephrolithiasis, nephrocalcinosis, ESRD | Thiazides may be tried Ophthalmologic screening Monitor for seizures Monitor for CKD |