Eighteen-year follow-up of a patient with partial hypoxanthine phosphoribosyltransferase deficiency and a new mutation

Hypoxanthine phosphoribosyltransferase (HPRT) deficiency is an inherited disorder. Complete deficiency of HPRT activity is phenotypically expressed as the devastating Lesch-Nyhan syndrome. Partial HPRT deficiency usually causes hyperuricemia, precocious gout, and uric acid nephrolithiasis. We descri...

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Published in:Pediatric nephrology (Berlin, West) West), 2005-09, Vol.20 (9), p.1346-1348
Main Authors: Gregoric, Alojz, Rabelink, Gwenda M, Kokalj Vokac, Nadja, Varda, Natasa Marcun, Zagradisnik, Boris
Format: Article
Language:English
Subjects:
Allopurinol - therapeutic use
Care and treatment
Case studies
Causes of
Child, Preschool
Diagnosis
Enzyme Inhibitors - therapeutic use
Follow-Up Studies
Gene mutations
Genetic disorders
Humans
Hyperuricemia
Hyperuricemia - drug therapy
Hyperuricemia - etiology
Hyperuricemia - genetics
Hypoxanthine Phosphoribosyltransferase - deficiency
Hypoxanthine Phosphoribosyltransferase - genetics
Lesch-Nyhan Syndrome - complications
Lesch-Nyhan Syndrome - genetics
Male
Point Mutation
Treatment Outcome
Uric Acid - metabolism
Urinary Calculi - etiology
Urinary Calculi - genetics
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Summary:Hypoxanthine phosphoribosyltransferase (HPRT) deficiency is an inherited disorder. Complete deficiency of HPRT activity is phenotypically expressed as the devastating Lesch-Nyhan syndrome. Partial HPRT deficiency usually causes hyperuricemia, precocious gout, and uric acid nephrolithiasis. We describe an 18-year follow-up of a 5-year old boy with partial HPRT deficiency and report a novel mutation in his HPRT gene. He presented with overproduction of uric acid and passage of uric acid renal stones, and without gout or neurological and behavioral abnormalities. Treatment with allopurinol, adequate hydration, urinary alkalization, and a low-purine diet was started. No subsequent nephrolithiasis has occurred. After 18-year of this therapy his physical and neuropsychological status were normal, merely his glomerular filtration rate (GFR, normal 97-137 mL min(-1)/1.73 m(2)) fell from normal to 65.1 mL min(-1). The most likely cause of initial renal impairment in our patient is uric and/or xanthine crystalluria. A missense and transition mutation 169A>G (57ATG>GTG, 57met>val) in exon 3 of the patient's HPRT gene was identified and the mother was the carrier of the mutation. As far as we are aware, the identified mutation has not previously been reported. We named the mutant HPRT Maribor.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-005-1935-4