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. 2022 Aug;37(8):1855-1866.
doi: 10.1007/s00467-021-05371-7. Epub 2022 Jan 16.

A broad clinical spectrum of PLCε1-related kidney disease and intrafamilial variability

Esra Karabağ Yılmaz  1 , Seha Saygili  1 , Bora Gulhan  2 , Nur Canpolat  1 , Aysun Karabay Bayazıt  3 , Beltinge Demircioglu Kilic  4 , Nurver Akıncı  5 , Meryem Benzer  6 , Nilufer Goknar  7 , Asli Kavaz Tufan  8 , Mukaddes Kalyoncu  9 , Hulya Nalcacioglu  10 , Demet Tekcan  10 , Gizem Yıldız  11 , Ayse Agbas  1 , Ahmet Nayır  12 , Rezan Topaloglu  2 , Salim Caliskan  1 , Fatih Ozaltin  13   14
Affiliations

A broad clinical spectrum of PLCε1-related kidney disease and intrafamilial variability

Esra Karabağ Yılmaz et al. Pediatr Nephrol. 2022 Aug.

Abstract

Background: The phenotypic and genotypic spectrum and kidney outcome of PLCε1-related kidney disease are not well known. We attempted to study 25 genetically confirmed cases of PLCε1-related kidney disease from 11 centers to expand the clinical spectrum and to determine the relationship between phenotypic and genotypic features, kidney outcome, and the impact of treatment on outcome.

Methods: Data regarding demographics, clinical and laboratory characteristics, histopathological and genetic test results, and treatments were evaluated retrospectively.

Results: Of 25 patients, 36% presented with isolated proteinuria, 28% with nephrotic syndrome, and 36% with chronic kidney disease stage 5. Twenty patients underwent kidney biopsy, 13 (65%) showed focal segmental glomerulosclerosis (FSGS), and 7 (35%) showed diffuse mesangial sclerosis (DMS). Of the mutations identified, 80% had non-missense, and 20% had missense; ten were novel. No clear genotype-phenotype correlation was observed; however, significant intrafamilial variations were observed in three families. Patients with isolated proteinuria had significantly better kidney survival than patients with nephrotic syndrome at onset (p = 0.0004). Patients with FSGS had significantly better kidney survival than patients with DMS (p = 0.007). Patients who presented with nephrotic syndrome did not respond to any immunosuppressive therapy; however, 4/9 children who presented with isolated proteinuria showed a decrease in proteinuria with steroids and/or calcineurin inhibitors.

Conclusion: PLCε1-related kidney disease may occur in a wide clinical spectrum, and genetic variations are not associated with clinical presentation or disease course. However, clinical presentation and histopathology appear to be important determinants for prognosis. Immunosuppressive medications in addition to angiotensin-converting enzyme inhibitors may be beneficial for selected patients. "A higher resolution version of the Graphical abstract is available as Supplementary information".

Keywords: Children; Diffuse mesangial sclerosis; Focal segmental glomerulosclerosis; Intrafamilial variability; PLCε1; Prognosis; Treatment.

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