Renal involvement in MELAS syndrome - a series of 5 cases and review of the literature.
Renal dysfunction is increasingly recognized as a potential clinical feature of mitochondrial cytopathies such as mitochondrial encephalomyopathy, lacticacidosis and stroke-like episodes (MELAS) syndrome. Five cases of MELAS syndrome with renal involvement from 4 unrelated families are presented in this case series. Three of the 5 patients had a history of maternally-inherited diabetes and/or deafness. Focal and segmental glomerulosclerosis and arteriolar hyaline thickening were the most striking findings on renal biopsy. In addition to clinical presentation with the typical symptoms of MELAS syndrome, genetic testing in these patients identified the A3243G point mutation in the tRNALeu gene of the mitochondrial DNA (mtDNA). The diagnosis of MELAS syndrome was thus considered to be unequivocal. The incidence of kidney disease in MELAS syndrome may be underestimated although a study is required to investigate this hypothesis. As the A3243G mtDNA mutation leads to a progressive adult-onset form of focal segmental glomerulosclerosis (FSGS), screening for the MELAS A3243G mtDNA mutation should therefore be performed especially in patients with maternally-inherited diabetes or hearing loss presenting with FSGS.
Alexandre
A
Seidowsky
Maxime
M
Hoffmann
François
F
Glowacki
Claire-Marie
CM
Dhaenens
Jean-Philippe
JP
Devaux
Celia Lessore
CL
de Sainte Foy
François
F
Provot
Jean-Dominique
JD
Gheerbrant
Aurelie
A
Hummel
Marc
M
Hazzan
Michel
M
Dracon
Anne
A
Dieux-Coeslier
Marie-Christine
MC
Copin
Christian
C
Noël
David
D
Buob
D000328:Adult; D004272:DNA, Mitochondrial / Q000235:genetics; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000209:etiology*; D017241:MELAS Syndrome / Q000150:complications* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation
D004272:DNA, Mitochondrial