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Multicenter Study
. 2023 Aug;38(8):2615-2622.
doi: 10.1007/s00467-023-05879-0. Epub 2023 Jan 23.

Genetic testing in children with nephrolithiasis and nephrocalcinosis

Ashley M Gefen  1 , Christine B Sethna  2 , Onur Cil  3 , Farzana Perwad  3 , Megan Schoettler  3 , Mini Michael  4 , Joseph R Angelo  4 , Adnan Safdar  5 , Louise Amlie-Wolf  6 , Tracy E Hunley  7 , Jonathan S Ellison  8 , Daniel Feig  9 , Joshua Zaritsky  10
Affiliations
Multicenter Study

Genetic testing in children with nephrolithiasis and nephrocalcinosis

Ashley M Gefen et al. Pediatr Nephrol. 2023 Aug.

Abstract

Background: Diagnosing genetic kidney disease has become more accessible with low-cost, rapid genetic testing. The study objectives were to determine genetic testing diagnostic yield and examine predictors of genetic diagnosis in children with nephrolithiasis/nephrocalcinosis (NL/NC).

Methods: This retrospective multicenter cross-sectional study was conducted on children ≤ 21 years old with NL/NC from pediatric nephrology/urology centers that underwent the Invitae Nephrolithiasis Panel 1/1/2019-9/30/2021. The diagnostic yield of the genetic panel was calculated. Bivariate and multiple logistic regression were performed to assess for predictors of positive genetic testing.

Results: One hundred and thirteen children (83 NL, 30 NC) from 7 centers were included. Genetic testing was positive in 32% overall (29% NL, 40% NC) with definite diagnoses (had pathogenic variants alone) made in 11.5%, probable diagnoses (carried a combination of pathogenic variants and variants of uncertain significance (VUS) in the same gene) made in 5.4%, and possible diagnoses (had VUS alone) made in 15.0%. Variants were found in 28 genes (most commonly HOGA1 in NL, SLC34A3 in NC) and 20 different conditions were identified. Compared to NL, those with NC were younger and had a higher proportion with developmental delay, hypercalcemia, low serum bicarbonate, hypophosphatemia, and chronic kidney disease. In multivariate analysis, low serum bicarbonate was associated with increased odds of genetic diagnosis (β 2.2, OR 8.7, 95% CI 1.4-54.7, p = 0.02).

Conclusions: Genetic testing was high-yield with definite, probable, or possible explanatory variants found in up to one-third of children with NL/NC and shows promise to improve clinical practice. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Children; Genetic kidney disease; Kidney stones; Nephrocalcinosis.

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Conflict of interest statement

Competing interests Alnylam Pharmaceuticals sponsored the program that paid for the genetic testing of the cohort. Ashley M. Gefen has received research support from Natera, Inc. Jonathan S. Ellison is a consultant for Alnylam Pharmaceuticals and contributes to UpToDate. Christine Sethna was on an advisory board for Trevere Therapeutics. No other authors have a conflict of interest.

Figures

Fig. 1
Fig. 1
Distribution of genetic diagnoses. NC, nephrocalcinosis; NL, nephrolithiasis
Fig. 2
Fig. 2
Genetic diagnoses overall. FHH1, familial hypocalciuric hypercalcemia type 1; FHHNC, familial hypomagnesemia with hypercalciuria and nephrocalcinosis; FIH, familial idiopathic hypercalciuria; HHRH, hereditary hypophosphatemic rickets with hypercalciuria; IH2, infantile hypercalcemia type 2; PH1, primary hyperoxaluria type 1; PH3, primary hyperoxaluria type 3; NPHLOP2, hypophosphatemic nephrolithiasis/osteoporosis 2
See this image and copyright information in PMC

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