Alport syndrome: significance of gingival biopsy in the initial diagnosis and periodontal evaluation after renal transplantation.
Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS.
Toygar
Hilal Uslu
HU
Department of Periodontology, Baskent University, Ankara, Turkey. usluhilaladana@yahoo.com
Toygar
Okan
O
Guzeldemir
Esra
E
Cilasun
Ulkem
U
Nacar
Ahmet
A
Bal
Nebil
N
D001485:Basement Membrane / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D024141:Collagen Type IV / Q000032:analysis; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D004848:Epithelium / Q000473:pathology; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology*; D005885:Gingival Hyperplasia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005890:Gingivectomy; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D046529:Microscopy, Electron, Transmission; D009394:Nephritis, Hereditary / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D055815:Young Adult
D015415:Biomarkers; D024141:Collagen Type IV; D007166:Immunosuppressive Agents; D016572:Cyclosporine