title: Genetic testing can resolve diagnostic confusion in Alport syndrome.
abstract: Alport syndrome (AS) is a familial glomerular disorder resulting from mutations in the genes encoding several members of the type IV collagen protein family. Despite advances in molecular genetics, renal biopsy remains an important initial diagnostic tool. Histological diagnosis is challenging as features may be non-specific, particularly early in the disease course and in females with X-linked disease. We present three families for whom there was difficulty in correctly diagnosing AS or thin basement membrane nephropathy as a result of misinterpretation of non-specific and incomplete histology. We highlight the importance of electron microscopy and immunofluorescence in improving diagnostic yield and also the hazard of interpreting a descriptive histological term as a diagnostic label. Molecular genetic testing allows a definitive diagnosis to be made in index patients and at-risk family members.
authors.affiliation: Newcastle Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Adam
authors.affiliation: West London Renal and Transplant Centre , Hammersmith Hospital , London , UK.
authors.forename: Thomas M F
authors.initials: TM
authors.lastname: Connor
authors.affiliation: Newcastle Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK.
authors.forename: Katrina
authors.initials: K
authors.lastname: Wood
authors.affiliation: The Oxford Kidney Unit , Churchill Hospital , Oxford , UK.
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.affiliation: Royal Berkshire Hospital , Reading , UK.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Naik
authors.affiliation: UCL Centre for Nephrology , Royal Free Hospital , London , UK.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Gale
authors.affiliation: Newcastle Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK ; Institute of Genetic Medicine , Newcastle University, International Centre for Life , Newcastle upon Tyne , UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Sayer
keywords: Alport syndrome; COL4A3; COL4A5; haematuria; molecular genetics