Predominant Liver Cystic Disease in a New Heterozygotic PKHD1 Variant: A Case Report

Abstract

BACKGROUND The polycystic kidney and hepatic disease 1 (PKHD1) gene codes for fibrocystin-polyductin, a protein that takes part in cell-signaling for cell differentiation, especially in kidney tubules and bile ducts. A homozygous or compound heterozygous defect in this gene can cause autosomal recessive polycystic kidney disease (ARPKD). Polycystic liver disease (PCLD) can also be caused by single heterozygous variants in the PKHD1 gene. ARPKD presents with renal insufficiency and cystic dilatation of bile ducts, although disease is not expected with a single heterozygous mutation. PCLD presents with multiple cysts in the liver and dilated bile ducts as well, but with less of an impact on the kidneys than with ARPKD. Our purpose in publishing this report is to introduce an as-yet unknown variant to the body of genetic defects associated with ARPKD and PCLD, as well as to argue for the likely pathogenicity of the variant according to the prevailing criteria used for classifying gene variants. CASE REPORT We present a patient with a de novo PKHD1 variant currently classified as a variant of unknown significance manifesting with bilaterally enlarged cystic kidneys and echogenic cystic structures in the hepatic portal system, indicative of cystic disease. CONCLUSIONS Given this patient's liver and kidney presentation that does not fully align with either ARPKD or PCLD, the authors believe that the single heterozygous variant in this patient's PKHD1 gene is worthy of reporting. This new single heterozygous variant in PKHD1 gene causing cystic kidney and cystic hepatic disease in the patient should be considered 'likely pathogenic' according to the criteria set by the American College of Medical Genetics.

Figure 1.

Transverse sonographic image of the liver demonstrates diffusely heterogeneous/coarsened architecture suggesting underlying hepatocellular disease.

Figure 2.

Transverse sonographic image of the liver in the periportal region shows ill-defined hyper-echoic regions adjacent to the portal vessels (arrows) which can reflect periportal fibrosis.

Figure 3.

Longitudinal sonographic image of the right kidney depicting large-for-age but otherwise normal-appearing kidney.

Figure 4.

Longitudinal sonographic image of the left kidney depicting a large-for-age but otherwise normal-appearing kidney.