title: The position of the polycystic kidney disease 1 (PKD1) gene mutation correlates with the severity of renal disease.
abstract: The severity of renal cystic disease in the major form of autosomal dominant polycystic kidney disease (PKD1) is highly variable. Clinical data was analyzed from 324 mutation-characterized PKD1 patients (80 families) to document factors associated with the renal outcome. The mean age to end-stage renal disease (ESRD) was 54 yr, with no significant difference between men and women and no association with the angiotensin-converting enzyme polymorphism. Considerable intrafamilial variability was observed, reflecting the influences of genetic modifiers and environmental factors. However, significant differences in outcome were also found among families, with rare examples of unusually late-onset PKD1. Possible phenotype/genotype correlations were evaluated by estimating the effects of covariants on the time to ESRD using proportional hazards models. In the total population, the location of the mutation (in relation to the median position; nucleotide 7812), but not the type, was associated with the age at onset of ESRD. Patients with mutations in the 5' region had significantly more severe disease than the 3' group; median time to ESRD was 53 and 56 yr, respectively (P = 0.025), with less than half the chance of adequate renal function at 60 yr (18.9% and 39.7%, respectively). This study has shown that the position of the PKD1 mutation is significantly associated with earlier ESRD and questions whether PKD1 mutations simply inactivate all products of the gene.
authors.affiliation: Division of Nephrology and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rossetti
authors.forename: Sarah
authors.initials: S
authors.lastname: Burton
authors.forename: Lana
authors.initials: L
authors.lastname: Strmecki
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.forename: Jośe L
authors.initials: JL
authors.lastname: San Millán
authors.forename: Klaus
authors.initials: K
authors.lastname: Zerres
authors.forename: T Martin
authors.initials: TM
authors.lastname: Barratt
authors.forename: Seza
authors.initials: S
authors.lastname: Ozen
authors.forename: Vicente E
authors.initials: VE
authors.lastname: Torres
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Winearls
authors.forename: Peter C
authors.initials: PC
authors.lastname: Harris
mesh_terms: D017668:Age of Onset; D000368:Aged; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007676:Kidney Failure, Chronic / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D017354:Point Mutation / Q000235:genetics*; D016891:Polycystic Kidney, Autosomal Dominant / Q000235:genetics*; D011110:Polymorphism, Genetic; D016016:Proportional Hazards Models