Novel frameshift mutation in a heterozygous woman with Fabry disease and end-stage renal failure.
It is generally accepted that Fabry disease (angiokeratoma corporis diffusum) is an X-linked disorder resulting from the deficient activity of the lysosomal enzyme alpha-galactosidase. In males, the enzymatic defect leads to accumulation of glycosphingolipids, particularly in the kidney which causes end-stage renal disease. We report here a woman who presented in 1987 with focal and segmental glomerulosclerosis and required hemodialysis 4 years later when her son was evaluated for proteinuria. In these patients morphologic, biochemical, and genetic investigations were performed to explore the possibility of a hereditary renal disorder. Ultrastructural examination of the son's renal biopsy specimen revealed lamellated osmiophilic inclusions in the glomeruli, typical of Fabry disease. Four months after kidney transplantation in the mother, a graft biopsy specimen also revealed dense lamellated inclusions on electron microscopy. The leukocyte alpha-galactosidase activity was 0.008 mumol/min.10(9) cells in the son and 0.070 in the mother (range 0.100-0.500 mumol/min.10(9) cells). The diagnosis of Fabry disease was confirmed in both patients by the identification by DNA sequencing of a novel mutation in the alpha-galactosidase gene: one single base pair deletion in exon 3 (7317delA).


CONCLUSIONS
(1) end-stage renal disease may occur in heterozygous women with Fabry disease; (2) morphologic lesions due to glycosphingolipid accumulation may be observed in the renal allograft after transplantation, and (3) DNA analysis confirmed the diagnosis by demonstrating a frameshift mutation, which has as yet not been reported.
Van Loo
A
A
Department of Nephrology, University Hospital, Gent, Belgium.
Vanholder
R
R
Madsen
K
K
Praet
M
M
Kint
J
J
De Paepe
A
A
Messiaen
L
L
Lameire
N
N
Hasholt
L
L
Sørensen
S A
SA
Ringoir
S
S
D000328:Adult; D001483:Base Sequence; D000795:Fabry Disease / Q000150:complications / Q000235:genetics* / Q000378:metabolism; D005260:Female; D016368:Frameshift Mutation; D006028:Glycosphingolipids / Q000378:metabolism; D006579:Heterozygote; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000648:ultrastructure; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D000519:alpha-Galactosidase / Q000235:genetics
D006028:Glycosphingolipids; D000519:alpha-Galactosidase