title: A case surviving for over a year of renal tubular dysgenesis with compound heterozygous angiotensinogen gene mutations.
abstract: Renal tubular dysgenesis (RTD) is a developmental abnormality of the renal proximal tubules found in patients with Potter syndrome. We report a female newborn with RTD who has survived for more than 18 months. Infusions of fresh frozen plasma (FFP) in the early neonatal period were effective in raising and maintaining her blood pressure. Peritoneal dialysis was required until the appearance of spontaneous urination at 29 days after birth. Histopathological examinations of the kidney revealed dilated renal tubular lumina and foamy columnar epithelial cells in the renal tubules. Endocrinological studies showed a discrepancy between low plasma renin activity (<0.1 ng/ml/hr) and high active renin concentration (135,000 pg/ml), suggesting an aberration in the renin substrate, angiotensinogen. Direct sequencing analysis revealed two novel mutations in the coding region of the angiotensinogen gene (AGT): a nonsense mutation in exon 2 (c.604C > T) and a frameshift deletion at nucleotide 1290 in exon 5 (c.1290delT). The mutations were in the compound heterozygous state, because each parent had each mutation. These findings suggest that angiotensinogen deficiency is one of the causes of RTD. A treatment of the condition with FFP may help to promote long survival.
authors.affiliation: Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan. uematsu@bk9.so-net.ne.jp
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Uematsu
authors.forename: Osamu
authors.initials: O
authors.lastname: Sakamoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nishio
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ohura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Inagaki
authors.forename: Takaaki
authors.initials: T
authors.lastname: Abe
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Okamura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kondo
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tsuchiya
mesh_terms: D000808:Angiotensinogen / Q000172:deficiency / Q000235:genetics*; D001483:Base Sequence; D018389:Codon, Nonsense; D004252:DNA Mutational Analysis; D017931:DNA Primers / Q000235:genetics; D005260:Female; D016368:Frameshift Mutation; D005808:Genes, Recessive; D006579:Heterozygote; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007687:Kidney Tubules, Proximal / Q000002:abnormalities*; D009154:Mutation; D017384:Sequence Deletion
chemical_list: D018389:Codon, Nonsense; D017931:DNA Primers; D000808:Angiotensinogen