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Nephronophthisis 12(NPHP12)

MedGen UID:
462536
Concept ID:
C3151186
Disease or Syndrome
Synonyms: NPHP12; TTC21B-Related Joubert Syndrome
 
Gene (location): TTC21B (2q24.3)
 
Monarch Initiative: MONDO:0013442
OMIM®: 613820

Definition

Classic Joubert syndrome (JS) is characterized by three primary findings: A distinctive cerebellar and brain stem malformation called the molar tooth sign (MTS). Hypotonia. Developmental delays. Often these findings are accompanied by episodic tachypnea or apnea and/or atypical eye movements. In general, the breathing abnormalities improve with age, truncal ataxia develops over time, and acquisition of gross motor milestones is delayed. Cognitive abilities are variable, ranging from severe intellectual disability to normal. Additional findings can include retinal dystrophy, renal disease, ocular colobomas, occipital encephalocele, hepatic fibrosis, polydactyly, oral hamartomas, and endocrine abnormalities. Both intra- and interfamilial variation are seen. [from GeneReviews]

Additional descriptions

From GeneReviews Overview
The nephronophthisis (NPH) phenotype is characterized by reduced renal concentrating ability, chronic tubulointerstitial nephritis, cystic renal disease, and progression to end-stage renal disease (ESRD) before age 30 years. Three age-based clinical subtypes are recognized: infantile, juvenile, and adolescent/adult. Infantile NPH can present in utero with oligohydramnios sequence (limb contractures, pulmonary hypoplasia, and facial dysmorphisms) or postnatally with renal manifestations that progress to ESRD before age 3 years. Juvenile NPH, the most prevalent subtype, typically presents with polydipsia and polyuria, growth retardation, chronic iron-resistant anemia, or other findings related to chronic kidney disease (CKD). Hypertension is typically absent due to salt wasting. ESRD develops at a median age of 13 years. Ultrasound findings are increased echogenicity, reduced corticomedullary differentiation, and renal cysts (in 50% of affected individuals). Histologic findings include tubulointerstitial fibrosis, thickened and disrupted tubular basement membrane, sporadic corticomedullary cysts, and normal or reduced kidney size. Adolescent/adult NPH is clinically similar to juvenile NPH, but ESRD develops at a median age of 19 years. Within a subtype, inter- and intrafamilial variability in rate of progression to ESRD is considerable. Approximately 80%-90% of individuals with the NPH phenotype have no extrarenal features (i.e., they have isolated NPH); ~10%-20% have extrarenal manifestations that constitute a recognizable syndrome (e.g., Joubert syndrome, Bardet-Biedl syndrome, Jeune syndrome and related skeletal disorders, Meckel-Gruber syndrome, Senior-Løken syndrome, Leber congenital amaurosis, COACH syndrome, and oculomotor apraxia, Cogan type).
From MedlinePlus Genetics
Nephronophthisis can occur as part of separate syndromes that affect other areas of the body; these are often referred to as nephronophthisis-associated ciliopathies. For example, Senior-Løken syndrome is characterized by the combination of nephronophthisis and a breakdown of the light-sensitive tissue at the back of the eye (retinal degeneration); Joubert syndrome affects many parts of the body, causing neurological problems and other features, which can include nephronophthisis.

About 85 percent of all cases of nephronophthisis are isolated, which means they occur without other signs and symptoms. Some people with nephronophthisis have additional features, which can include liver fibrosis, heart abnormalities, or mirror image reversal of the position of one or more organs inside the body (situs inversus).

Nephronophthisis eventually leads to end-stage renal disease (ESRD), a life-threatening failure of kidney function that occurs when the kidneys are no longer able to filter fluids and waste products from the body effectively. Nephronophthisis can be classified by the approximate age at which ESRD begins: around age 1 (infantile), around age 13 (juvenile), and around age 19 (adolescent).

Nephronophthisis is a disorder that affects the kidneys. It is characterized by inflammation and scarring (fibrosis) that impairs kidney function. These abnormalities lead to increased urine production (polyuria), excessive thirst (polydipsia), general weakness, and extreme tiredness (fatigue). In addition, affected individuals develop fluid-filled cysts in the kidneys, usually in an area known as the corticomedullary region. Another feature of nephronophthisis is a shortage of red blood cells, a condition known as anemia.  https://medlineplus.gov/genetics/condition/nephronophthisis

Clinical features

From HPO
Nephronophthisis
MedGen UID:
146912
Concept ID:
C0687120
Disease or Syndrome
The nephronophthisis (NPH) phenotype is characterized by reduced renal concentrating ability, chronic tubulointerstitial nephritis, cystic renal disease, and progression to end-stage renal disease (ESRD) before age 30 years. Three age-based clinical subtypes are recognized: infantile, juvenile, and adolescent/adult. Infantile NPH can present in utero with oligohydramnios sequence (limb contractures, pulmonary hypoplasia, and facial dysmorphisms) or postnatally with renal manifestations that progress to ESRD before age 3 years. Juvenile NPH, the most prevalent subtype, typically presents with polydipsia and polyuria, growth retardation, chronic iron-resistant anemia, or other findings related to chronic kidney disease (CKD). Hypertension is typically absent due to salt wasting. ESRD develops at a median age of 13 years. Ultrasound findings are increased echogenicity, reduced corticomedullary differentiation, and renal cysts (in 50% of affected individuals). Histologic findings include tubulointerstitial fibrosis, thickened and disrupted tubular basement membrane, sporadic corticomedullary cysts, and normal or reduced kidney size. Adolescent/adult NPH is clinically similar to juvenile NPH, but ESRD develops at a median age of 19 years. Within a subtype, inter- and intrafamilial variability in rate of progression to ESRD is considerable. Approximately 80%-90% of individuals with the NPH phenotype have no extrarenal features (i.e., they have isolated NPH); ~10%-20% have extrarenal manifestations that constitute a recognizable syndrome (e.g., Joubert syndrome, Bardet-Biedl syndrome, Jeune syndrome and related skeletal disorders, Meckel-Gruber syndrome, Senior-Løken syndrome, Leber congenital amaurosis, COACH syndrome, and oculomotor apraxia, Cogan type).
Stage 5 chronic kidney disease
MedGen UID:
384526
Concept ID:
C2316810
Disease or Syndrome
A degree of kidney failure severe enough to require dialysis or kidney transplantation for survival characterized by a severe reduction in glomerular filtration rate (less than 15 ml/min/1.73 m2) and other manifestations including increased serum creatinine.

Professional guidelines

PubMed

Li J, Su X, Zhang H, Wu W, Li J, Chen Y, Li J, Fu Q, Wu C, Zhong X, Wang C, Liu L
Pediatr Nephrol 2023 May;38(5):1609-1620. Epub 2022 Oct 13 doi: 10.1007/s00467-022-05763-3. PMID: 36227438Free PMC Article
Tang X, Liu C, Liu X, Chen J, Fan X, Liu J, Ma D, Cao G, Chen Z, Xu D, Zhu Y, Jiang X, Cheng L, Wu Y, Hou L, Li Y, Shao X, Zheng S, Zhang A, Zheng B, Jian S, Rong Z, Su Q, Gao X, Rao J, Shen Q, Xu H; Chinese Children Genetic Kidney Disease Database (CCGKDD); “Internet Plus” Nephrology Alliance of the National Center for Children’s Care
J Med Genet 2022 Feb;59(2):147-154. Epub 2020 Dec 15 doi: 10.1136/jmedgenet-2020-107184. PMID: 33323469
Thomas CP, Gupta S, Freese ME, Chouhan KK, Dantuma MI, Holanda DG, Katz DA, Darbro BW, Mansilla MA, Smith RJ
Transpl Int 2021 Dec;34(12):2696-2705. Epub 2021 Nov 3 doi: 10.1111/tri.14133. PMID: 34632641

Recent clinical studies

Etiology

Thomas CP, Gupta S, Freese ME, Chouhan KK, Dantuma MI, Holanda DG, Katz DA, Darbro BW, Mansilla MA, Smith RJ
Transpl Int 2021 Dec;34(12):2696-2705. Epub 2021 Nov 3 doi: 10.1111/tri.14133. PMID: 34632641
Scherdel P, Reynaud R, Pietrement C, Salaün JF, Bellaïche M, Arnould M, Chevallier B, Piloquet H, Jobez E, Cheymol J, Bichara E; EBGM III study group, Heude B, Chalumeau M
PLoS One 2017;12(4):e0176464. Epub 2017 Apr 27 doi: 10.1371/journal.pone.0176464. PMID: 28448550Free PMC Article
Halbritter J, Porath JD, Diaz KA, Braun DA, Kohl S, Chaki M, Allen SJ, Soliman NA, Hildebrandt F, Otto EA; GPN Study Group
Hum Genet 2013 Aug;132(8):865-84. Epub 2013 Apr 5 doi: 10.1007/s00439-013-1297-0. PMID: 23559409Free PMC Article
Mason SB, Lai X, Ringham HN, Bacallao RL, Harris PC, Witzmann FA, Gattone VH 2nd
Nephron Exp Nephrol 2011;117(2):e31-8. Epub 2010 Aug 6 doi: 10.1159/000319722. PMID: 20693816Free PMC Article
Fiskerstrand T, Houge G, Sund S, Scheie D, Leh S, Boman H, Knappskog PM
J Mol Diagn 2010 Jan;12(1):125-31. Epub 2009 Dec 10 doi: 10.2353/jmoldx.2010.090033. PMID: 20007846Free PMC Article

Diagnosis

Hudson R, Patel C, Hawley CM, O'Shea S, Snelling P, Ho G, Holman K, Bennetts B, Crawford J, Francis L, Simons C, Mallett A
Am J Kidney Dis 2020 Aug;76(2):282-287. Epub 2019 Dec 4 doi: 10.1053/j.ajkd.2019.08.031. PMID: 31810733
Snoek R, van Setten J, Keating BJ, Israni AK, Jacobson PA, Oetting WS, Matas AJ, Mannon RB, Zhang Z, Zhang W, Hao K, Murphy B, Reindl-Schwaighofer R, Heinzl A, Oberbauer R, Viklicky O, Conlon PJ, Stapleton CP, Bakker SJL, Snieder H, Peters EDJ, van der Zwaag B, Knoers NVAM, de Borst MH, van Eerde AM
J Am Soc Nephrol 2018 Jun;29(6):1772-1779. Epub 2018 Apr 13 doi: 10.1681/ASN.2017111200. PMID: 29654215Free PMC Article
Scherdel P, Reynaud R, Pietrement C, Salaün JF, Bellaïche M, Arnould M, Chevallier B, Piloquet H, Jobez E, Cheymol J, Bichara E; EBGM III study group, Heude B, Chalumeau M
PLoS One 2017;12(4):e0176464. Epub 2017 Apr 27 doi: 10.1371/journal.pone.0176464. PMID: 28448550Free PMC Article
Kang HG, Lee HK, Ahn YH, Joung JG, Nam J, Kim NK, Ko JM, Cho MH, Shin JI, Kim J, Park HW, Park YS, Ha IS, Chung WY, Lee DY, Kim SY, Park WY, Cheong HI
Exp Mol Med 2016 Aug 5;48(8):e251. doi: 10.1038/emm.2016.63. PMID: 27491411Free PMC Article
Halbritter J, Porath JD, Diaz KA, Braun DA, Kohl S, Chaki M, Allen SJ, Soliman NA, Hildebrandt F, Otto EA; GPN Study Group
Hum Genet 2013 Aug;132(8):865-84. Epub 2013 Apr 5 doi: 10.1007/s00439-013-1297-0. PMID: 23559409Free PMC Article

Therapy

Avcı B, Baskın E, Gülleroğlu K, Çaltık Yılmaz A, Kantar A, Akdur A, Moray G, Haberal M
Exp Clin Transplant 2022 May;20(Suppl 3):122-125. doi: 10.6002/ect.PediatricSymp2022.O39. PMID: 35570616
Bruce G, Chaudhury S, Reynolds B
BMJ Case Rep 2020 Jul 16;13(7) doi: 10.1136/bcr-2020-234810. PMID: 32675115Free PMC Article
Stokman MF, Bijnsdorp IV, Schelfhorst T, Pham TV, Piersma SR, Knol JC, Giles RH, Bongers EMHF, Knoers NVAM, Lilien MR, Jiménez CR, Renkema KY
J Proteomics 2019 Feb 10;192:27-36. Epub 2018 Jul 30 doi: 10.1016/j.jprot.2018.07.008. PMID: 30071318
Derakhshan N, Derakhshan D, Torabinejad S, Derakhshan A
Saudi J Kidney Dis Transpl 2011 Jan;22(1):123-5. PMID: 21196627
Henriksson C, Andersen HJ, Gustafsson A, Gelin LE
Acta Paediatr Scand 1975 Nov;64(6):833-8. doi: 10.1111/j.1651-2227.1975.tb03933.x. PMID: 171908

Prognosis

Snoek R, van Setten J, Keating BJ, Israni AK, Jacobson PA, Oetting WS, Matas AJ, Mannon RB, Zhang Z, Zhang W, Hao K, Murphy B, Reindl-Schwaighofer R, Heinzl A, Oberbauer R, Viklicky O, Conlon PJ, Stapleton CP, Bakker SJL, Snieder H, Peters EDJ, van der Zwaag B, Knoers NVAM, de Borst MH, van Eerde AM
J Am Soc Nephrol 2018 Jun;29(6):1772-1779. Epub 2018 Apr 13 doi: 10.1681/ASN.2017111200. PMID: 29654215Free PMC Article
Quaglia M, Musetti C, Ghiggeri GM, Fogazzi GB, Settanni F, Boldorini RL, Lazzarich E, Airoldi A, Izzo C, Giordano M, Stratta P
Clin Transplant 2014 Sep;28(9):995-1003. Epub 2014 Jul 18 doi: 10.1111/ctr.12408. PMID: 24961278
Albaramki J, Akl K, Hamed R, Wahbeh A
Saudi J Kidney Dis Transpl 2014 May;25(3):630-3. doi: 10.4103/1319-2442.132218. PMID: 24821164
Tsukamoto T, Tanaka M, Komiya T, Ueda S, Takasu K, Takahara S, Koizumi A, Muso E
Clin Exp Nephrol 2008 Feb;12(1):82-8. Epub 2008 Jan 5 doi: 10.1007/s10157-007-0004-7. PMID: 18175055
Scolari F, Ghiggeri GM, Casari G, Amoroso A, Puzzer D, Caridi GL, Valzorio B, Tardanico R, Vizzardi V, Savoldi S, Viola BF, Bossini N, Prati E, Gusmano R, Maiorca R
Nephrol Dial Transplant 1998 Oct;13(10):2536-46. doi: 10.1093/ndt/13.10.2536. PMID: 9794556

Clinical prediction guides

Yuan B, Liu P, Gupta A, Beck CR, Tejomurtula A, Campbell IM, Gambin T, Simmons AD, Withers MA, Harris RA, Rogers J, Schwartz DC, Lupski JR
PLoS Genet 2015 Dec;11(12):e1005686. Epub 2015 Dec 7 doi: 10.1371/journal.pgen.1005686. PMID: 26641089Free PMC Article
Albaramki J, Akl K, Hamed R, Wahbeh A
Saudi J Kidney Dis Transpl 2014 May;25(3):630-3. doi: 10.4103/1319-2442.132218. PMID: 24821164
Fiskerstrand T, Houge G, Sund S, Scheie D, Leh S, Boman H, Knappskog PM
J Mol Diagn 2010 Jan;12(1):125-31. Epub 2009 Dec 10 doi: 10.2353/jmoldx.2010.090033. PMID: 20007846Free PMC Article
Salomon R, Saunier S, Niaudet P
Pediatr Nephrol 2009 Dec;24(12):2333-44. Epub 2008 Jul 8 doi: 10.1007/s00467-008-0840-z. PMID: 18607645Free PMC Article
Ala-Mello S, Sankila EM, Koskimies O, de la Chapelle A, Kääriäinen H
J Med Genet 1998 Apr;35(4):279-83. doi: 10.1136/jmg.35.4.279. PMID: 9598719Free PMC Article

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