A comparison of the clinical, histopathologic, and ultrastructural phenotypes in carriers of X-linked and autosomal recessive Alport's syndrome

• Published in: American journal of kidney diseases Vol. 38; no. 6; pp. 1217 - 1228
• Main Authors: Dagher, Hayat, Buzza, Mark, Colville, Deb, Jones, Colin, Powell, Harley, Fassett, Rob, Wilson, Diane, Agar, John, Savige, Judy
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Orlando, FL Elsevier Inc 01-12-2001; Elsevier
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Alport's syndrome; Biological and medical sciences; Biopsy; Child; collagen type IV; Comorbidity; Eye Abnormalities - epidemiology; Female; Genetic Carrier Screening; Genetic Linkage; glomerular basement membrane (GBM); Glomerulonephritis; Hearing Loss - epidemiology; hematuria; Humans; Kidney - pathology; Kidney Glomerulus - ultrastructure; Kidney Tubules - ultrastructure; lenticonus; Male; Medical sciences; Middle Aged; Nephritis, Hereditary - diagnosis; Nephritis, Hereditary - epidemiology; Nephritis, Hereditary - genetics; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Phenotype; Sex Distribution; hematuria; Alport's syndrome; collagen type IV; glomerular basement membrane (GBM); lenticonus; Glomerulonephritis; Kidney disease; Human; Urinary system disease; Linkage; Hematuria; Biological marker; Hemorrhage; Genetic disease; Basement membrane; Renal glomerulus; Pathology; Symptomatology; Phenotype; Histopathology; Autosomal character; Alport syndrome; Recessive character; X-Chromosome; Comparative study
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/ajkd.2001.29217

Previous series that described phenotypes in carriers of Alport's syndrome did not distinguish genetically between carriers of X-linked and autosomal recessive disease. In this study, modes of inheritance in unselected families with Alport's syndrome associated with two city and two provincial hospitals were determined using microsatellite markers, and carriers of disease haplotypes were identified within these families. All 47 carriers (100%) from 18 families with X-linked Alport's syndrome had dysmorphic hematuria on phase-contrast microscopy, but few developed renal failure (3 of 40 carriers; 8%), clinical hearing loss (2 of 45 carriers; 4%), retinopathy (1 of 30 carriers; 3%), or lenticonus (0 of 30 carriers; 0%). Eleven of the 14 carriers (79%) from 2 families with autosomal recessive disease had dysmorphic hematuria, but none had renal failure, clinical hearing loss, retinopathy, or lenticonus. Urinary red blood cell counts in carriers of X-linked Alport's syndrome were greater than those in carriers of autosomal recessive disease (P < 0.0001), but the frequency of proteinuria and hypertension and levels of proteinuria were not different. There was more tubulointerstitial damage in carriers of X-linked disease (P = 0.012); however, carriers of autosomal recessive disease had more widespread and more uniform thinning of the glomerular basement membrane (P < 0.0001) and less lamellation (P < 0.04). © 2001 by the National Kidney Foundation, Inc.