Clinical and molecular characterization of a large primary hyperoxaluria cohort from Saudi Arabia: a retrospective study

• Published in: Pediatric nephrology (Berlin, West) West), 2023-06, Vol.38 (6), p.1801-1810
• Main Authors: Alfadhel, Majid, Umair, Muhammad, Alghamdi, Malak A., Al Fakeeh, Khalid, Al Qahtani, Abdullah T., Farahat, Afrah, Shalaby, Mohamed A., Kari, Jameela A., Raina, Rupesh, Cochat, Pierre, Alhasan, Khalid A.
• Format: Article
• Language: English
• Subjects: AGXT gene; Calcinosis; Care and treatment; Clinical aspects; Consanguinity; Diagnosis; Enzymes; Female; Females; Gastrointestinal surgery; Health aspects; Health sciences; Hematuria; Hospitals; Humans; Hyperoxaluria; Hyperoxaluria, Primary - complications; Hyperoxaluria, Primary - diagnosis; Hyperoxaluria, Primary - epidemiology; Kidney diseases; Lithiasis; Male; Medical research; Medicine; Medicine & Public Health; Metabolism; Military reserves; Nephrocalcinosis - diagnosis; Nephrocalcinosis - epidemiology; Nephrocalcinosis - genetics; Nephrolithiasis; Nephrolithiasis - genetics; Nephrology; Original; Original Article; Oxaluria; Pediatrics; Phenotypes; Primary hyperoxaluria; Proteinuria; Renal failure; Research centers; Retrospective Studies; Saudi Arabia - epidemiology; Urinary tract diseases; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-022-05784-y

Background Primary hyperoxalurias (PHs) constitute rare disorders resulting in abnormal glyoxalate metabolism. PH-associated phenotypes range from progressive nephrocalcinosis and/or recurrent urolithiasis to early kidney failure. Methods A retrospective study was conducted for patients with confirmed PH diagnoses from three tertiary centers in Saudi Arabia. Detailed clinical molecular diagnosis was performed for 25 affected individuals. Whole exome sequencing (WES)–based molecular diagnosis was performed for all affected individuals. Results The male:female ratio was 52% male ( n  = 13) and 48% female ( n  = 12), and consanguinity was present in 88%. Nephrolithiasis and/or nephrocalcinosis were present in all patients. Kidney stones were present in 72%, nephrocalcinosis in 60%, hematuria in 32%, proteinuria in 16%, abdominal pain in 36%, developmental delay in 8%, and chronic kidney disease stage 5 (CKD stage 5) was observed in 28% of the patients. The most common PH disorder was type I caused by variants in the  AGXT  gene, accounting for 56%. The  GRHPR  gene variants were identified in 4 patients, 16% of the total cases. Seven patients did not reveal any associated variants. Missense variants were the most commonly observed variants (48%), followed by frame-shift duplication variants (28%). Conclusions Characterization of the genetic and clinical aspects of PH in this unique population provides direction for improved patient management and further research. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information