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Multicenter Study
. 2014 May;85(5):1169-78.
doi: 10.1038/ki.2013.519. Epub 2014 Jan 8.

Genotype-phenotype associations in WT1 glomerulopathy

Beata S Lipska  1 , Bruno Ranchin  2 , Paraskevas Iatropoulos  3 , Jutta Gellermann  4 , Anette Melk  5 , Fatih Ozaltin  6 , Gianluca Caridi  7 , Tomas Seeman  8 , Kalman Tory  9 , Augustina Jankauskiene  10 , Aleksandra Zurowska  11 , Maria Szczepanska  12 , Anna Wasilewska  13 , Jerome Harambat  14 , Agnes Trautmann  15 , Amira Peco-Antic  16 , Halina Borzecka  17 , Anna Moczulska  18 , Bassam Saeed  19 , Radovan Bogdanovic  20 , Mukaddes Kalyoncu  21 , Eva Simkova  22 , Ozlem Erdogan  23 , Kristina Vrljicak  24 , Ana Teixeira  25 , Marta Azocar  26 , Franz Schaefer  15 ; PodoNet Consortium
Collaborators, Affiliations
Free article
Multicenter Study

Genotype-phenotype associations in WT1 glomerulopathy

Beata S Lipska et al. Kidney Int. 2014 May.
Free article

Abstract

WT1 mutations cause a wide spectrum of renal and extrarenal manifestations. Here we evaluated disease prevalence, phenotype spectrum, and genotype-phenotype correlations of 61 patients with WT1-related steroid-resistant nephrotic syndrome relative to 700 WT1-negative patients, all with steroid-resistant nephrotic syndrome. WT1 patients more frequently presented with chronic kidney disease and hypertension at diagnosis and exhibited more rapid disease progression. Focal segmental glomerulosclerosis was equally prevalent in both cohorts, but diffuse mesangial sclerosis was largely specific for WT1 disease and was present in 34% of cases. Sex reversal and/or urogenital abnormalities (52%), Wilms tumor (38%), and gonadoblastoma (5%) were almost exclusive to WT1 disease. Missense substitutions affecting DNA-binding residues were associated with diffuse mesangial sclerosis (74%), early steroid-resistant nephrotic syndrome onset, and rapid progression to ESRD. Truncating mutations conferred the highest Wilms tumor risk (78%) but typically late-onset steroid-resistant nephrotic syndrome. Intronic (KTS) mutations were most likely to present as isolated steroid-resistant nephrotic syndrome (37%) with a median onset at an age of 4.5 years, focal segmental glomerulosclerosis on biopsy, and slow progression (median ESRD age 13.6 years). Thus, there is a wide range of expressivity, solid genotype-phenotype associations, and a high risk and significance of extrarenal complications in WT1-associated nephropathy. We suggest that all children with steroid-resistant nephrotic syndrome undergo WT1 gene screening.

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