Phenotype and genotype characterization of adenine phosphoribosyltransferase deficiency.

Abstract

Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder causing 2,8-dihydroxyadenine stones and renal failure secondary to intratubular crystalline precipitation. Little is known regarding the clinical presentation of APRT deficiency, especially in the white population. We retrospectively reviewed all 53 cases of APRT deficiency (from 43 families) identified at a single institution between 1978 and 2009. The median age at diagnosis was 36.3 years (range 0.5 to 78.0 years). In many patients, a several-year delay separated the onset of symptoms and diagnosis. Of the 40 patients from 33 families with full clinical data available, 14 (35%) had decreased renal function at diagnosis. Diagnosis occurred in six (15%) patients after reaching ESRD, with five diagnoses made at the time of disease recurrence in a renal allograft. Eight (20%) patients reached ESRD during a median follow-up of 74 months. Thirty-one families underwent APRT sequencing, which identified 54 (87%) mutant alleles on the 62 chromosomes analyzed. We identified 18 distinct mutations. A single T insertion in a splice donor site in intron 4 (IVS4 + 2insT), which produces a truncated protein, accounted for 40.3% of the mutations. We detected the IVS4 + 2insT mutation in two (0.98%) of 204 chromosomes of healthy newborns. This report, which is the largest published series of APRT deficiency to date, highlights the underdiagnosis and potential severity of this disease. Early diagnosis is crucial for initiation of effective treatment with allopurinol and for prevention of renal complications.

• Authors: Guillaume Bollée, Cécile Dollinger, Lucile Boutaud, Delphine Guillemot, Albert Bensman, Jérôme Harambat, Patrice Deteix, Michel Daudon, Bertrand Knebelmann, Irène Ceballos-Picot
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 21 Issue 4 Pg. 679-88 (Apr 2010) ISSN: 1533-3450 [Electronic] United States
• PMID: 20150536 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adenine Phosphoribosyltransferase

Topics

• Adenine Phosphoribosyltransferase (deficiency)
• Adolescent
• Adult
• Aged
• Algorithms
• Child
• Child, Preschool
• Female
• France
• Genetic Diseases, Inborn (diagnosis, genetics)
• Genotype
• Humans
• Infant
• Male
• Middle Aged
• Phenotype
• Retrospective Studies
• Young Adult