title: Hypertension is a characteristic complication of X-linked hypophosphatemia.
abstract: X-linked hypophosphatemia (XLH) is a group of rare disorders caused by defective proximal tubular reabsorption of phosphate. Mutations in the PHEX gene are responsible for the majority of cases. There are very few reports of long-term complications of XLH other than skeletal and dental diseases. The aim of this study was to identify the phenotypic presentation of XLH during adulthood including complications other than skeletal and dental diseases. The clinical and biochemical phenotype of 22 adult patients with a PHEX gene mutation were examined retrospectively from their medical records. 6 patients had hypertension. The average age of hypertension onset was 29.0 years. Secondary hyperparathyroidism preceded the development of hypertension in 5 patients. 1 patient developed tertiary hyperparathyroidism. 15 patients had nephrocalcinosis. 2 patients had chronic renal dysfunction. Patients with hypertension had a significantly lower eGFR (p=0.010) compared to patients without hypertension. No significant difference was found in any other parameters. To examine the genotype-phenotype correlation, 10 adult males were chosen for analysis. No significant genotype-phenotype correlation analysis was revealed in any of the complications. However, there was a possibility that the age at nephrocalcinosis onset was younger in the non-missense mutation group than in the missense mutation group (p=0.063). This study corroborated the view that early-onset hypertension could be one of the characteristic complications seen in XLH patients. Considering the limited number of our patients, further study is necessary to address a potential cause of hypertension. XLH patients require careful lifelong treatment.
authors.affiliation: Division of Genetic Research, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Masaki
authors.initials: M
authors.lastname: Takagi
authors.forename: Ryojun
authors.initials: R
authors.lastname: Takeda
authors.forename: Kentaro
authors.initials: K
authors.lastname: Miyai
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D053098:Familial Hypophosphatemic Rickets / Q000178:diet therapy / Q000235:genetics / Q000503:physiopathology*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008499:Medical Records; D009154:Mutation; D009397:Nephrocalcinosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D053402:PHEX Phosphate Regulating Neutral Endopeptidase / Q000235:genetics; D010710:Phosphates / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies; D014041:Tokyo / Q000453:epidemiology; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D006887:Hydroxycholecalciferols; D010710:Phosphates; D053402:PHEX Phosphate Regulating Neutral Endopeptidase; C506231:PHEX protein, human; C008088:alfacalcidol