Recommendations and guidelines for the diagnosis and treatment of Fabry nephropathy in adults.
Progressive loss of kidney function complicates Fabry disease, an X-linked lysosomal storage disorder that arises from deficiency of alpha-galactosidase activity. Heterozygous females with Fabry disease can be as severely affected as hemizygous males, who have the classic form of the disease. Enzyme-replacement therapy with recombinant human alpha-galactosidase clears the glycosphingolipid globotriaosylceramide from kidney cells, and can stabilize renal function in adults with mild to moderate Fabry nephropathy. However, adults with more advanced nephropathy and overt proteinuria do not respond as well. For these patients, antiproteinuric therapy given in conjunction with enzyme-replacement therapy might prevent further decline in kidney function. In this Review, we propose guidelines and recommendations for the diagnosis and management of Fabry nephropathy in adults, based on published data and on the consensus of opinion of participants in the 7(th) International Fabry Nephropathy Roundtable in 2007. These organ-specific guidelines could be easier to implement than general guidelines, provided they are used in the context of an overall multisystem care approach.
Ortiz
Alberto
A
Dialysis Unit, Universidad Autónoma de Madrid, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, 28040 Madrid, Spain. aortiz@fjd.es
Oliveira
João P
JP
Wanner
Christoph
C
Brenner
Barry M
BM
Waldek
Stephen
S
Warnock
David G
DG
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001707:Biopsy, Needle; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D000795:Fabry Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D014281:Trihexosylceramides / Q000627:therapeutic use; D000519:alpha-Galactosidase / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D014281:Trihexosylceramides; C018549:globotriaosylceramide; D003404:Creatinine; D000519:alpha-Galactosidase