Tubulopathy

Tubulopathy
SpecialtyUrology 
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Tubulopathy is a disease affecting the renal tubules of the nephron.[1]

Tubulopathic processes may be inflammatory or noninflammatory, though inflammatory processes are often referred to specifically as tubulitis.[2][3]

Characteristics of Some Inherited Tubulopathies[4]
Disorder [OMIM Number]Protein DefectChromosome LocalizationInheritanceClinical Features/NotesBiochemical Features
Proximal Tubule
Lowe's syndrome (oculocerebral dystrophy [309000]OCRL1Xq26.1XRHydrophthalmia, cataract, mental retardation, hyporeflexia, hypotonia and progressive kidney failure, normotensivePlasma: ↓K, ↓CO2; Urine: ↑LMWP, ↑AA, ↑PO4, ↑K
Wilson's disease [277900]ATP7B13q14.3-q21.1ARLiver disease or neurologic symptoms, or both, Kayser-Fleischer rings, normotensivePlasma: ↑free copper, abnormal LFTs; Urine: ↑copper excretion, ↑LMWP, ↑AA, ↑PO4, ↑Glycosuria
Dent's disease (X-linked recessive hypophophatemic rickets)[300009]CLCN5Xp11.22XRNephrocalcinosis, nephrolithiasis, rachitic and osteomalacic bone disease, progressive kidney failure, normotensivePlasma: ↓PO4, N/↓K; Urine: ↑LMWP, ↑AA, ↑K, ↑Ca, ↑PO4, ↑Glycosuria
X-linked dominant hypophosphatemic rickets [307800PHEXXp22.2-p22.1XDGrowth retardation, rachitic and osteomalacic bone disease, hypophosphatemia, and renal defects in phosphate reabsorption and vitamin D metabolismPlasma: ↓PO4, ↑ALP; Urine: ↑PO4
Loop of Henle
Bartter's syndromeNKCC2 (type 1)15q15-21.1ARPolyuria, polydipsia, muscle weakness, hypovolemia, normotensive or hypotensive (all types). Maternal polyhydramnios, premature birth, perinatal salt wasting, nephrocalcinosis and kidney stones (type 1 and 2), milder phenotype with normocalciuria(type 3), sensorineural deafness, motor retardation, renal failure (type 4)Plasma: ↑renin, ↓K, ↑CO2, mild ↓Mg in some patients; Urine: ↑Ca
[601678]ROMK (type 2)11q24AR
[241200]C1C-Kb (type 3, classic)1p36AR
[607364]1p31AR
[602522]Barttin (type 4)
Hypomagnesemic hypercalciuric nephrocalcinosis (magnesium-losing kidney)[248250]PCLN13q27ARNephrocalcinosis, renal failure, ocular/hearing defects, polyruria, polydipsia, recurrent urinary tract infections, recurrent renal colic, normotensivePlasma: ↓Mg, ↑PTH; Urine: ↑Ca, ↑Mg
Distal Tubule/Collecting Duct
Liddle's syndrome [177200]ENaC (activating)16p13-p12ADEarly, and frequently severe, hypertension, strokePlasma: ↓renin, ↓K, ↓Mg, ↑CO2; Urine: ↑K
Pseudohypoaldosteronism type 1a [264350]ENaC (inactivating)12p13, 16p13-p12ARPresents in infancy with salt-wasting and hypotension, Cough, respiratory infectionsPlasma: ↑renin, ↓Na, ↑K, ↓CO2; Urine: ↑K
Pseudohypoaldosteronism type 1b [177735]Mineralocorticoid receptor4q31.1ADPresents in infancy with salt-wasting and hypotension. Milder than type 1a and remits with agePlasma: ↑renin, ↓Na, ↑K, ↓CO2; Urine: ↑K
Pseudohypoaldosteronism type 2 (Gordon's syndrome) [145260]Unknown (?WNK)1q31-q42, 12p13, 17q21-q22ADHypertension (± muscle weakness, short stature, intellectual impairment). Correction of physiologic abnormalities by thiazide diureticsPlasma: ↓renin, ↑K, ↓CO2, ↑Cl; Urine: ↓K
Gitelman's syndrome [263800]NCCT16q13ARHypotension, weakness, paresthesias, tetany, fatigue, and salt craving, Presentation generally much later in life than in Bartter's and hypocalciuria is typicalPlasma: ↑renin, ↓K, ↓Mg, ↑CO2; Urine: ↓calcium:creatinine excretion ratio (useful in distinguishing Gitelman's and Bartter's)(Note: biochemically can mimic thiazide use)
X-linked nephrogenic diabetes insipidus type 1 [304800]V2 receptorXq28XRHyperthermia, polyuria, polydipsia, dehydration, inability to form concentrated urine, mental retardation if diagnosis delayed. Symptoms in infancyHyperosmolar plasma, dilute urine
Autosomal dominant nephrogenic diabetes insipidus type 2 [192340]AQP212q13AD and ARPolyuria, polydipsia, dehydration, inability to form concentrated urine. Symptoms after first year of lifeHyperosmolar plasma, dilute urine

AA: Aminoaciduria; AD:autosomal dominant; AR: autosomal recessive; LFT's: Liver function tests; LMWP: low molecular weight proteinuria; XD: X-linked dominant; XR: X-linked recessive; PTH: Parathyroid hormone

References

  1. "tubulopathy" at Dorland's Medical Dictionary
  2. Ferrara P, D'Aleo CM, Rigante D, et al. (2003). "Amoxicillin-induced nephritis and tubulitis in a child". Urol. Int. 71 (1): 124–6. doi:10.1159/000071111. PMID 12845278.
  3. Robertson H, Wong WK, Talbot D, Burt AD, Kirby JA (January 2001). "Tubulitis after renal transplantation: demonstration of an association between CD103+ T cells, transforming growth factor beta1 expression and rejection grade". Transplantation. 71 (2): 306–13. doi:10.1097/00007890-200101270-00024. PMID 11213078.
  4. Burtis, C.A.; Ashwood, E.R. and Bruns, D.E. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th Edition. Elsevier Saunders. p.1574-1575


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