Alport综合征(AS),肾衰竭风险很高的遗传性肾病,归因于编码IV型胶原蛋白的基因COL4A3,COL4A4和COL4A5中的致病变体。下一代测序(NGS)越来越多地应用于AS的诊断,但是复杂的基因型-表型相关性,也就是说,识别变异的意义,仍然是一个巨大的临床挑战。在这项研究中,我们报道了一例27岁的中国女性,有血尿和蛋白尿家族史。值得注意的是,先证者是她家庭中唯一一个肾功能不全的人。NGS是在这个家庭中表演的,并且发现先证者是COL4A3基因中两个变体的复合杂合子:c.2990G>A继承自父亲,c.4981C>T继承自母亲。我们对相应蛋白质的空间结构进行了建模,并假设结构异常导致IV型胶原蛋白网络的破坏,肾小球基底膜的主要组成部分。因此,先证者被诊断为常染色体隐性遗传AS,以肾小球基底膜严重缺陷为特征。因此,先证者显示肾功能丧失。此病例介绍强调了NGS对AS诊断的重要性,并介绍了一种新的AS基因型。
Alport syndrome (AS), a hereditary kidney disease with a high risk for renal failure, is attributed to pathogenic variants in genes
COL4A3, COL4A4, and COL4A5 that encode type IV collagen. Next-generation sequencing (NGS) is increasingly applied to the diagnosis of AS, but complex genotype-phenotype correlation, that is, identifying the significance of variants, is still a huge clinical challenge. In this study, we reported the
case of a 27-year-old Chinese woman with a family history of hematuria and proteinuria. Notably, the proband is the only one in her family with renal insufficiency. NGS was performed in this family, and it was revealed that the proband was a compound heterozygote for two variants in the
COL4A3 gene: c.2990G>A inherited from her father and c.4981C>T inherited from her mother. We modeled the spatial structure of the corresponding protein and assumed that structural abnormalities led to the breakdown of type IV collagen networks, a major component of the glomerular basement membrane. Thus, the proband was diagnosed with autosomal recessive AS, characterized by severe defects of the glomerular basement membrane. Hence, the proband showed a loss of renal function. This
case presentation emphasizes the importance of NGS for AS diagnosis and introduces a novel genotype of AS.