Follow-up results of patients with ADCK4 mutations and the efficacy of CoQ10 treatment

• Published in: Pediatric nephrology (Berlin, West) West), 2017-08, Vol.32 (8), p.1369-1375
• Main Authors: Atmaca, Mustafa, Gulhan, Bora, Korkmaz, Emine, Inozu, Mihriban, Soylemezoglu, Oguz, Candan, Cengiz, Bayazıt, Aysun Karabay, Elmacı, Ahmet Midhat, Parmaksiz, Gonul, Duzova, Ali, Besbas, Nesrin, Topaloglu, Rezan, Ozaltin, Fatih
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adult; Age; Albuminuria - diagnosis; Albuminuria - drug therapy; Albuminuria - genetics; Albuminuria - urine; Child; Child, Preschool; Coenzyme Q10; Diagnosis; Diagnosis, Differential; Differential diagnosis; DNA Mutational Analysis; Drug Resistance; End-stage renal disease; Epidermal growth factor receptors; Etiology; Female; Follow-Up Studies; Gene mutation; Genetic aspects; Genetic screening; Genetic Testing; Glomerular Filtration Rate; Glomerulonephritis; Glucocorticoids - pharmacology; Glucocorticoids - therapeutic use; Humans; Kidney - drug effects; Kidney - pathology; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - genetics; Kidney transplantation; Male; Medicine; Medicine & Public Health; Mutation; Nephrology; Nephrotic syndrome; Nephrotic Syndrome - diagnosis; Nephrotic Syndrome - drug therapy; Nephrotic Syndrome - genetics; Original Article; Patients; Pediatrics; Physiological aspects; Protein Kinases - genetics; Proteinuria; Renal failure; Risk factors; Supplements; Teenagers; Time Factors; Treatment Outcome; Turkey; Ubiquinone - analogs & derivatives; Ubiquinone - therapeutic use; Urology; Vitamins - therapeutic use; Young Adult
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-017-3634-3

Background ADCK4-related glomerulopathy is an important differential diagnosis in adolescents with steroid-resistant nephrotic syndrome (SRNS) and/or chronic kidney disease (CKD) of unknown origin. We screened adolescent patients to determine the frequency of ADCK4 mutation and the efficacy of early CoQ10 administration. Methods A total of 146 index patients aged 10–18 years, with newly diagnosed non-nephrotic proteinuria, nephrotic syndrome, or chronic renal failure and end-stage kidney disease (ESKD) of unknown etiology were screened for ADCK4 mutation. Results Twenty-eight individuals with bi-allelic mutation from 11 families were identified. Median age at diagnosis was 12.4 (interquartile range [IQR] 8.04–19.7) years. Upon first admission, all patients had albuminuria and 18 had CKD (6 ESKD). Eight were diagnosed either through the screening of family members following index case identification or during genetic investigation of proteinuria in an individual with a history of a transplanted sibling. Median age of these 8 patients was 21.5 (range 4.4–39) years. CoQ10 supplementation was administered following genetic diagnosis. Median estimated glomerular filtration rate (eGFR) just before CoQ10 administration was 140 (IQR 117–155) ml/min/1.73m 2 , proteinuria was 1,008 (IQR 281–1,567) mg/m 2 /day. After a median follow-up of 11.5 (range 4–21) months following CoQ10 administration, proteinuria was significantly decreased (median 363 [IQR 175–561] mg/m 2 /day, P =0.025), whereas eGFR was preserved (median 137 [IQR 113–158] ml/min/1.73m 2 , P =0.61). Conclusions ADCK4 mutations are one of the most common causes of adolescent-onset albuminuria and/or CKD of unknown etiology in Turkey. CoQ10 supplementation appears efficacious at reducing proteinuria, and may thereby be renoprotective.