Abstract | BACKGROUND:
Denys-Drash syndrome (DDS) is associated with mutations of the Wilms' tumour 1 (WT1) gene, and is characterized by pseudohermaphroditism, a progressive glomerulopathy, and the development of Wilms' tumour. More than 90% of patients with DDS who carry constitutional intragenic WT1 mutations are at high risk (90%) for the development of Wilms' tumour. WT1 is a signalling protein with 90% of WT1 mutations occurring in the WT1 zinc finger region as single nucleotide polymorphisms, the majority of which are missense mutations. METHODS: Constitutional DNA was extracted from peripheral blood. Direct sequencing and restriction enzymes were employed to analyse mutations. RESULTS: Two children, 46XY males who had evidence of pseudohermaphroditism, hypogonadism and renal failure with a glomerulopathy atypical for DDS, but no Wilms' tumour or nephroblastomatosis, on investigation, prior to transplant, were identified with missense mutations in the WT1 gene, in exons 8 and 9, respectively. The decision to do prophylactic nephrectomies was based on the genetic identification of WT1 mutations supporting a diagnosis of incomplete DDS, with the potential for increased risk of malignancy with the development of Wilms' tumour. The nephrectomy specimens demonstrated nephrogenic rests (nephroblastomatosis), which have a potential for malignant transformation. CONCLUSIONS: WT1 missense mutations in exons 8 and 9 can be regarded as having the potential for malignant change supporting prophylactic nephrectomy in apparent incomplete DDS patients with end-stage renal disease.
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Authors | Min Hu, Geoff Y Zhang, Susan Arbuckle, Nicole Graf, Albert Shun, Martin Silink, Deborah Lewis, Stephen I Alexander |
Journal | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
(Nephrol Dial Transplant)
Vol. 19
Issue 1
Pg. 223-6
(Jan 2004)
ISSN: 0931-0509 [Print] England |
PMID | 14671061
(Publication Type: Case Reports, Journal Article)
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Topics |
- Child
- Denys-Drash Syndrome
(complications, genetics)
- Genes, Wilms Tumor
(physiology)
- Humans
- Infant
- Kidney Failure, Chronic
(etiology, genetics)
- Kidney Neoplasms
(genetics, surgery)
- Male
- Mutation, Missense
- Nephrectomy
(methods)
- Precancerous Conditions
(genetics, surgery)
- Wilms Tumor
(genetics, surgery)
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