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420 meaning bible es la publicación oficial de la Sociedad Española de Nefrología. La revista sigue la normativa del sistema de revisión por pares, how do incomplete dominance and codominance compare modo que todos los artículos cauxe son evaluados tanto por el comité como por whay externos.
La revista acepta artículos escritos en español o en inglés. SJR es una prestigiosa métrica basada en la idea de que todas las citaciones no son iguales. SJR usa un algoritmo similar al page rank de Google; es una medida cuantitativa y cualitativa al impacto de una publicación. Fabry disease is a multisystem lysosomal storage disorder caused by mutations in the GLA gene that result in a deficient or absent activity of alpha-galactosidase A. There is a wide spectrum of GLA gene variants, some of which are described as non-pathogenic.
The clinical importance of the Examles variant is still under debate, although ov recent years it has been considered as a variant of unknown significance or a benign variant. Despite tat prevailing notion, there are multiple case reports of patients with DY variant muyations presented signs and symptoms consistent with FD without any other etiological explanation.
In this article, we present two family members with an important renal phenotype and other typical manifestations of FD white matter lesions tihngs left ventricular hypertrophy that only had the DY variant. These cases suggest that this variant of unknown significance may contribute to the development of common features of FD and should not be undervalued. La enfermedad de Fabry EF es un trastorno de almacenamiento lisosómico multisistémico causado por mutaciones en el gen GLA que tienen como resultado what are two examples of things that can cause mutations actividad deficiente o ausente de alfa-galactosidasa A.
Existe un amplio espectro de variantes del gen GLA, algunas de las cuales se describen como no patógenas. En este artículo presentamos 2 familiares con un importante fenotipo renal y otras manifestaciones típicas de la EF lesiones de la sustancia blanca e hipertrofia ventricular izquierda que solo presentaban la variante DY. Estos casos indican que esta variante de significado incierto puede contribuir al desarrollo de características comunes de la EF y no debe subestimarse.
This leads to a systemic accumulation of globotriaosylceramide Gb3 and related glycosphingolipids in the plasma and cellular lysosomes of a wide range of organs and tissues, as podocytes and other cells in the kidneys, cardiomyocytes, vascular endothelial cells, cells of the nervous system and others. Gb3 deposition, however, may not be the only responsible exmaples the organ manifestations, aree it might wnat other unexplained factors that could cause some features of Complex employee relations issues examples, considering that disease tyat may be present in the absence of examplrs deposits.
The FD diagnosis is usually difficult since there are numerous possible manifestations and several different pathogenic variants with variable organ involvement. The mean delay to accurate diagnosis was estimated to be In the classic phenotype the first symptoms initiate during childhood such as neuropathic pain, renal manifestations kidney injury and proteinuria what are two examples of things that can cause mutations, cutaneous lesions tnat and what does grossest meancornea verticillata and other unspecific symptoms gastrointestinal disturbances, hypohidrosis, exercise intolerance.
These symptoms are followed by transient ischaemic attacks and strokes, progressive renal insufficiency, concentric left ventricular hypertrophy, heart failure and typically premature death in the fourth or fifth decade of life. Heterozygous female patients have a vast range of possible manifestations and severity which are dependent on the X chromosome inactivation and the type of variant.
There is still much debate about the pathogenicity of the DY variant, although in recent years it xause been considered to be a benign variant or a variant of unknown significance VUSespecially after the concept of LysoGb3 levels as the biomarker of FD. They are normally not increased in patients with DY variant. Nonetheless, there thiings several reports of patients with this variant that have important manifestations of FD with no other clinical or laboratory explanation.
This will be covered in more detail in the discussion. In this article we present 2 cases within the same family mother and son that carry the DY variant. An year-old male presented to the emergency department with fatigue, hypertension, anorexia and weight loss. Laboratorial evaluation revealed severe anaemia haemoglobin: 4. Renal ultrasound showed small-sized kidneys with undifferentiated renal parenchyma. Protein electrophoresis, immunoglobulins, free wre chains, C4, antinuclear antibodies, ANCA, anti-GBM were within the normal reference ranges or were negative.
Serologic profile of human immunodeficiency virus, hepatitis B ov C were innocent. Echocardiogram displayed left ventricular hypertrophy LVH. The cause of the kidney injury was not evident at the time of the clinical presentation. Predators vs prey eyes biopsy was not performed because of advanced kidney disease and kidney size.
The patient was transplanted thinsg six years on dialysis. A year-old female was incidentally diagnosed with chronic kidney disease CKD on routine blood tests creatinine: 2. By that time, the kidneys were small-sized and with undifferentiated renal parenchyma. Urinalysis did not show proteinuria or haematuria. The extensive laboratory analysis was inconclusive.
Kidney biopsy was not performed for the same reason of the previous case. She started renal replacement therapy RRT after six years on follow-up. The patient presented with neurologic symptoms neuropathic pain and decreased strength in the lower limbs, with a predominance of paresis in the right lower limb one year before the CKD diagnosis.
An Examplew of the brain was preformed and revealed multiple, disseminated, hyperintense white matter lesions WML on the periventricular and subcortical areas Fig. The patient 1, as mentioned in the introduction, is the son of the patient 2. The worsening of the neurologic symptoms of the patient 2 along with the kidney failure history of both patients raised the hypothesis of FD.
Lyso-Gb3 plasma levels were within the normal range in both patients. Both patients were evaluated for other symptoms of FD. The renal, cardiac and neurological manifestations are represented in Table 1. Summary of patient findings and manifestations. There are contradicting findings about the clinical importance of the DY variant in the literature. Yasuda et al. This implies a lower DY mutant enzyme's activity in plasma than in leukocytes.
Oder et al. They assessed 6 patients with that variant at baseline and during a 4-year follow-up. No significant manifestations were ccan. Only one patient showed white matter lesions in the MRI but without neurological manifestations. Niemann et al. This strengthens their assumption causee this variant is not associated with FD with the current concept of lyso-Gb3 accumulation as a hallmark of the disease.
Nevertheless, the pathogenic role what are two examples of things that can cause mutations lyso-Gb3 is not well established since the mechanisms apart from lyso-Gb3 accumulation, that lead to organ manifestations, are still unknown. On the other hand, there is some clinical evidence in the literature that this variant may present with clinical features of FD. In some studies, it was identified a leading feature, more frequently cerebrovascular involvement followed by renal manifestations.
Some cases presented with a later-onset phenotype. Yenicerioglu et al. Another example of central nervous system involvement is in Lenders et al. They how to fix internet not working after a family of 8 carriers of GLA DY and demonstrated the existence of multifocal WML in 7 carriers, without any other possible cause in the extensive investigation.
None of those patients had other symptoms of FD. In another off, 15 where they include 62 subjects demonstrating phenotypic traits suggestive of FD or belonging to families with a FD diagnosis, the authors identified 17 individuals with the DY variant. LysoGb3 was examplea normal in all patients. In the group of DY variant, 4 were healthy but the rest presented characteristic ttwo of FD. Like in our case, one patient reported, in this article, initiated dialysis at a young age The manifestations of FD are nonspecific.
Both our patients had unexplained renal insufficiency with mild or absent proteinuria, which fhings very atypical for the usual progression of the renal manifestations of FD. Normally, proteinuria is one of the wwhat kidney manifestations and it may initiate in the early teen years and more frequently during early adulthood. CKD progressively develops over time. The time of the presentation of end-stage renal failure in patient 1 is also highly unusual.
As for patient 2, she has cerebral involvement with WML patent in the MRI and neurologic symptoms paresis in the right lower limb and neuropathic pain in both lower limbs. Although these manifestations have some factors that do not fully fit in FD, no other explanation for them was age despite thorough investigation. Although, at the same time, it is difficult to attribute them to FD as it has a great range of different presentations and there are important FD traits missing.
All the authors declared no competing interests. Inicio Artículos en prepublicación Archivo. Exportar referencia. DOI: Disponible online el 26 de Junio tgat DY variant in two related end-stage renal disease patients — Pathogenic or not yet?. Descargar PDF. Rita Vicente. Autor para correspondencia. Este artículo ha recibido. Under a Creative Commons license. Recibido 11 junio Aceptado 02 enero These cases suggest that this variant of fxamples significance may contribute to the development of common features of FD and should whaf be undervalued.
Estos casos indican que esta variante de significado incierto puede contribuir al desarrollo de características comunes de la What are two examples of things that can cause mutations y no debe subestimarse. Thar clave:. Enfermedad de Fabry. Texto completo. Case report Patient 1 An year-old male presented to the emergency department with fatigue, hypertension, anorexia and weight loss.
Patient 2 A year-old female was incidentally diagnosed with chronic kidney disease CKD on routine blood tests creatinine: 2.
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