Síndrome nefrótico congénito por mutación del gen de la nefrina. Caso clínico

Abstract

Congenital Nephrotic Syndrome (CNS) is defined as a corticoresistant nephrotic syndrome which appears in the first 90 days of life. NPHS1 gene mutations, codifying nephrine cause nearly 40% of the cases. Such a clinical case has not yet been described in Chile. Objetive: Describe a patient with CNS and his genetic study. Clinical case: Full-term 38 week male newborn, birthweight 2620 gr, height 48,5 cm, APGAR 9/10. Head circumf: 33 cm. First child well controlled pregnancy. 16 days after birth, he develops edema, massive proteinuria (3,2 gr/ dl), hypoalbuminemia (0,79 mg/dl) and hypercholesterolemia (total cholesterol: 318 mg/dl). Renal sonogram showed increase in size and echogenicity in both kidneys, and loss of corticomedullar differentiation. Renal biopsy showed diffuse mesangial glomeruloesclerosis. Genetic study for NPHS1 was performed through direct sequencing of 29 exons and adjacent regions of introns chromosome 19q13.1. Analysis disclosed C567X, ho-mozygote mutation. Conclusions: The first case of Nephrine mutation causing CNS is described in Chile. The importance of genetic studies in these patients is highlighted for clinical decisionmaking.