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Open Access Case report

A complex microdeletion 17q12 phenotype in a patient with recurrent de novo membranous nephropathy

Bernward Hinkes15*, Karl F Hilgers2, Hanno J Bolz3, Margarete Goppelt-Struebe2, Kerstin Amann4, Sandra Nagl3, Carsten Bergmann3, Wolfgang Rascher1, Kai-Uwe Eckardt2 and Johannes Jacobi2

Author affiliations

1 Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany

2 Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany

3 Center for Human Genetics, Bioscientia, Ingelheim, Germany

4 Department of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany

5 Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany

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Citation and License

BMC Nephrology 2012, 13:27  doi:10.1186/1471-2369-13-27

Published: 14 May 2012

Abstract

Background

Microdeletions on chromosome 17q12 cause of diverse spectrum of disorders and have only recently been identified as a rare cause of Mayer-Rokitansky-Kuester-Hauser-Syndrome (MRKH), which is characterized by uterus aplasia ± partial/complete vaginal aplasia in females with a regular karyotype. For the first time we report about a patient with a 17q12 microdeletion who is affected by MRKH in combination with a vascular and soft tissue disorder. Repeatedly she suffered from kidney transplant failure caused by consuming membranous nephropathy.

Case presentation

A 38-year-old female patient had been diagnosed with right kidney aplasia, left kidney dysplasia and significantly impaired renal function during infancy. Aged 16 she had to start hemodialysis. Three years later she received her first kidney transplant. Only then she was diagnosed with MRKH. The kidney transplant was lost due to consuming nephrotic syndrome caused by de novo membranous nephropathy, as was a second kidney transplant years later. In addition, a hyperelasticity syndrome affects the patient with congenital joint laxity, kyphoscoliosis, bilateral hip dysplasia, persistent hypermobility of both elbows, knees and hips. Her clinical picture resembles a combination of traits of a hypermobile and a vascular form of Ehlers-Danlos-Syndrome, but no mutations in the COL3A1 gene was underlying. Instead, array-based comparative genomic hybridisation (CGH) detected a heterozygous 1.43 Mb deletion on chromosome 17q12 encompassing the two renal developmental genes HNF1β and LHX1.

Conclusions

Deletions of HNF1β have recently drawn significant attention in pediatric nephrology as an important cause of prenatally hyperechogenic kidneys, renal aplasia and renal hypodysplasia. In contrast, membranous nephropathy represents an often-unaccounted cause of nephrotic syndrome in the adult population. A causative connection between theses two conditions has never been postulated, but is suggestive enough in this case to hypothesize it.

Keywords:
Microdeletion 17q12 syndrome; Mayer-Rokitansky-Kuester-Hauser-Syndrome membranous nephropathy; Nephrotic syndrome; HNF1β; LHX1