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Dent's Disease

What is Dent's Disease?

Dent disease is a rare X-linked recessive, chronic kidney condition found almost exclusively in males. The severity of the disease and the specific symptoms can vary. Females, who can be carriers for the disorder, can present with mild manifestations including low molecular weight proteinuria (increased leakage of small proteins in the urine) or hypercalciuria (high urinary calcium levels). Carriers may also be more likely to have a kidney stone, but this is not yet established for sure. Female carriers have a 50% chance of passing the altered chromosome to their child. If the child who received the Dent gene is a male they will have Dent disease.  If the child is a female they will be a carrier (since they will have another X chromosome from their father).  Males with Dent disease most commonly leak large amounts amounts of low molecular weight proteins in their urine.  Affected males also most often have hypercalciuria (elevated urinary calcium).  Dent patients can develop kidney stones or a more diffuse kidney calcification called nephrocalcinosis.  Dent patients are at risk for chronic kidney disease, and some require dialysis or kidney transplantation later in life.  However, some Dent patients will instead have very mild manifestations throughout their life.  Because many of these findings can be asymptomatic, especially the chronic kidney disease, it is important that Dent patients are followed by a physician that understands the disease.

Two forms of Dent disease exist (Type 1 & Type 2) that that are caused by changes in 2 different genes called CLCN5 (Type 1) and OCRL1 (Type 2). OCRL1 mutations can also cause Lowe syndrome, which in addition to kidney problems is also associated with intellectual deficits, elevated muscle enzymes, and cataracts.  It is not clear why patients with Dent type 2 have mostly renal problems but not the other systemic effects, or if they occur they are mild. For example cataracts associated with Type 2 Dent disease are mild and usually do not affect vision.

 

Synonyms

  • Dent disease 1
  • X-linked recessive nephrolithiasis with renal failure
  • X-linked recessive hypercalciuric hypophosphatemic rickets
  • Idiopathic Low-molecular-weight proteinuria with hypercalciuria and nephrocalcinosis
  • Dent disease 2

Dent disease is a rare X-linked recessive, chronic kidney condition found almost exclusively in males. The severity of the disease and the specific symptoms can vary. Females, who can be carriers for the disorder, can present with mild manifestations including low molecular weight proteinuria (increased leakage of small proteins in the urine) or hypercalciuria (high urinary calcium levels). Carriers may also be more likely to have a kidney stone, but this is not yet established for sure. Female carriers have a 50% chance of passing the altered chromosome to their child. If the child who received the Dent gene is a male they will have Dent disease.  If the child is a female they will be a carrier (since they will have another X chromosome from their father).  Males with Dent disease most commonly leak large amounts amounts of low molecular weight proteins in their urine.  Affected males also most often have hypercalciuria (elevated urinary calcium).  Dent patients can develop kidney stones or a more diffuse kidney calcification called nephrocalcinosis.  Dent patients are at risk for chronic kidney disease, and some require dialysis or kidney transplantation later in life.  However, some Dent patients will instead have very mild manifestations throughout their life.  Because many of these findings can be asymptomatic, especially the chronic kidney disease, it is important that Dent patients are followed by a physician that understands the disease.

Two forms of Dent disease exist (Type 1 & Type 2) that that are caused by changes in 2 different genes called CLCN5 (Type 1) and OCRL1 (Type 2). OCRL1 mutations can also cause Lowe syndrome, which in addition to kidney problems is also associated with intellectual deficits, elevated muscle enzymes, and cataracts.  It is not clear why patients with Dent type 2 have mostly renal problems but not the other systemic effects, or if they occur they are mild. For example cataracts associated with Type 2 Dent disease are mild and usually do not affect vision.

Rareshare would like to acknowledge Dr. Lada Beara Lasic, Assistant Professor of Medicine, Division of Nephrology, NYU Medical school and Dr. John Lieke, Professor of Medicine, Mayo Clinic, for reviewing this content.

At least 250 affected families have been reported to date with Dent disease. Dent disease Type 1 is more common than Type 2. Rare disease prevalence and incidence rates are difficult to accurately determine because of frequent misdiagnosis, or because people often go undiagnosed or unreported.

Name Abbreviation
Dent disease 1 Dent disease
X-linked recessive nephrolithiasis with renal failure Dent disease
X-linked recessive hypercalciuric hypophosphatemic rickets Dent disease
Idiopathic Low-molecular-weight proteinuria with hypercalciuria and nephrocalcinosis Dent disease
Dent disease 2 Dent disease

Mutations in the CLCN5 gene can give rise to Dent disease 1, whereas the OCRL gene causes. Dent disease 2. Both genes are important for the normal function of the proximal tubules, the kidney structure where the filtration and reabsorption of water and minerals takes place. Disrupting these genes will disrupt the normal function of the kidney and give rise to symptoms of this disease.

Dent disease is inherited in an X-linked recessive pattern. Both genes associated with this condition are located on the X chromosome, which is one of the two sex chromosomes. Females have two X chromosomes and males have one X and one Y chromosome. The altered gene is passed on from a mother to her son. Women with an altered CLCN5 or OCRL gene usually do not show any symptoms of the disorder, most likely due to their second X chromosome (with an unaltered form of the gene) compensating for the altered gene on the other X chromosome. Sometimes, female carriers can develop mild disease manifestations. In males (who have only one X chromosome), one altered copy of either of these genes in each cell is enough to cause the condition. A characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons, since fathers pass on a Y chromosome (and not an X chromosome) to their sons. Affected males will pass on the altered gene to all of their daughters, who will thus be carriers for the disorder.

The specific disease manifestations vary greatly from person to person, even among affected individuals within the same family.

The most common manifestations are proteinuria (elevated levels of proteins in the urine, especially of low molecular weight or small proteins) and hypercalciuria (elevated levels of calcium in the urine).

Some individuals can also develop deposits of calcium in the kidney (nephrocalcinosis), and more rarely kidney stones. People with kidney stones can experience painful urination, abdominal pain, a block of the urinary tract and recurrent urinary tract infections. Affected patients may also develop low levels of potassium, phosphate, rickets and decreased growth. Many affected patients will develop a progressive loss of kidney function and may need kidney replacement therapies like kidney transplantation or dialysis.

People with Dent disease type 2, in addition to these symptoms, can also experience mild intellectual disability, elevated muscle enzymes and cataracts without vision problems.

The diagnosis of Dent disease can be strongly suggested by finding elevated low molecular weight proteins in the urine (usually over 5-fold the normal range) together with other typical findings. Commonly measured low molecular weight proteins include β2-microglobulin, α1-microglobulinand/or retinol binding protein (RBP). Additional findings consistent with Dent disease include: excessive calcium in the urine (hypercalciuria; generally indicated by greater than 4mg/kg of calcium in a 24 hour urine collection), the presence of kidney stones, the deposition of calcium in the kidneys (nephrocalcinosis), the presence of red blood cells in the urine (hematuria), abnormally low phosphate levels in the blood (hypophosphatemia), impaired kidney function (chronic kidney disease) and a history of Dent disease in the family that follows an X-linked pattern. The diagnosis may be confirmed by a genetic test.

Urine tests can be done to detect the presence of low molecular weight proteins and calcium. Blood tests may reveal low potassium and low phosphate levels. A genetic test may help confirm the diagnosis. The genetic tests examine the chromosomes to detect changes in the 2 genes known to cause Dent disease (CLCN5 and OCRL1).

There is no specific treatment for this condition. Symptoms are treated as they present themselves. Thiazides diuretics can be used to reduce the levels of calcium in the urine and prevent the formation of kidney stones. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) can be used to diminish the amount of proteins in the urine and try to prevent kidney damage, although this approach may not work well in Dent disease. Sometimes patients are given potassium citrate for prevention of kidney stones.

However, the efficacy of these treatments is unclear and they can cause side effects. Potassium and phosphate supplements are used to correct low potassium or phosphate levels.

If the condition progresses to end-stage kidney disease, dialysis or a kidney transplant might be needed.

People with Dent disease have a good vital prognosis. End stage kidney disease has been reported to occur in 30% to 80% of males between 30 and 50 years old. However, Dent patients do well with kidney transplantation, and the disease cannot recur in a transplanted kidney.

Dent’s disease severity differs on a case by case basis. Individuals with Dent’s disease may experience mild symptoms such as low molecular weight proteins and calcium in their urine without other symptoms of discomfort. Others may experience kidney stones, chronic kidney disease, and even kidney failure. Some cases of Dent’s disease can worsen over a person’s lifetime, leading to kidney problems and kidney failure between the ages of 30 to 50. Still others can continue a relatively symptom-free life managing their symptoms and taking care to prevent kidney degeneration.

The Rare Kidney Stone Consortium at the Mayo Clinic has established a registry of individuals with rare or otherwise unidentified kidney problems. Registering as a part of this list provides doctors and researchers with more information to find linkages and conduct more research on rare diseases. For more information, e-mail rarekidneystones@mayo.edu

https://rarediseases.org/rare-diseases/dent-disease/

https://ghr.nlm.nih.gov/condition/dent-disease

https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-5-28

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=1652

 

Together We're Better! Created by Jill Brown Goodrich
Last updated 16 Dec 2024, 07:45 AM

Posted by
16 Dec 2024, 07:45 AM

Hello! I use a translator, so my message may not be correct.

I am the mother of a 7-year-old boy with type 1 dent disease. Which of the forum participants has type 1? How old are you? What are you being treated with and what are the results? My son was prescribed: Enalaprilum to fight protein in the urine, as well as Blemaren to fight calcium deposits in the kidneys.

At the moment, he has stage 1 chronic kidney disease, protein in the urine up to 1 gram and calcium deposits in the kidney pyramids. 

I wonder at what age the deterioration occurs. I want to know what to prepare for.

 

Posted by jenniferdawn24
22 Nov 2020, 06:32 PM

Hi Jill!!! I am excited to get to know all of you!!!!

Jen

Posted by Jill Brown Goodrich
22 Nov 2020, 06:26 PM

Greetings beloved Dent community!

The time is NOW! So many advances in science and so many people in need!

Please respond with your intentions to join in on the conversation about how we can find a cure and BEAT Dent disease! Together we're better!!!

All my love! Jill (The Dent Disease Foundation, The Dented Kidney)

RDCRN Survey Created by LadaBL
Last updated 29 Sep 2016, 11:45 AM

Posted by debduarte
29 Sep 2016, 11:45 AM

Lada, is this different from the registry at Mayo? Deb Duarte

Posted by LadaBL
28 Sep 2016, 04:25 PM

Dear Dent mothers, fathers and patients, We have worked hard to create the survey at RDCRN (Rare Disease Clinical Research Network - NIH sponsored). No good response yet - only about 10 patients finished. Link below, please consider!!! https://www.rarediseasesnetwork.org/cms/rksc/Get-Involved/Contact-Registry This is an easier, faster form of research and allows people from all over the world to do it. You will be asked to join contact registry and then do the survey. Good luck! Takes 10 min for moms and a little longer for patients - parents can do that one as well, even if kids are over 18! Please remember, the outcomes of this disease depend on your participation. It is a slow process, but if there is no process, there will be no outcome. My warmest regards, Lada

Various Symptoms of Dents Created by emilysorenson
Last updated 28 Sep 2016, 10:14 PM

Posted by LadaBL
28 Sep 2016, 10:14 PM

Ask them to do phosphorus, FGF 23 and 1,25 vitamin D. Good luck! Who is your nephrologist?

Posted by kjsjd
28 Sep 2016, 09:36 PM

Hi Lada We are in the UK - I met you when you came to the RKD symposium 2 years ago. My son is on the Dents registry and we have filled out all the forms again recently for Barbra Seide... He is also now seeing a metabolic specialist, so if you let me know what tests you require, I can ask at our next appointment in October.

Posted by LadaBL
28 Sep 2016, 08:34 PM

What is his serum phosphorus? If you are in the US, we could include him in phosphorus study and measure phosphorus related hormones which I believe are extremely important for growth but not routinely measured. Lada

View Full Thread (9 more posts)
Recurrent stones, post transplant Created by valgraham
Last updated 17 Jun 2016, 09:03 PM

Posted by valgraham
17 Jun 2016, 09:03 PM

Hi K - good to hear from you. Glad your son's kidney function is stable. FJ is doing ok, thanks. Been on dialysis for a year but we're hoping he will get a kidney transplant later this year, fingers crossed!

Posted by kjsjd
6 Jun 2016, 04:06 PM

HI Val - not been on the site for a while. How is FJ doing? We met in London 2 years ago. My son is now 14 and has been on potassium citrate for several years now. His kidney function is stable and well maintained with no sign of stones as yet. Best wishes. K

Posted by valgraham
16 Nov 2015, 10:02 PM

Thanks you, Minu. That is very helpful and encouraging news. Sorry your husband has had problems too. FJ has always had stones, but fortunately they haven't caused him problems so far. Interestingly, he has never been prescribed or taken potassium citrate.

View Full Thread (5 more posts)
1st Dent clinical trial by Mayo Clinic Created by LadaBL
Last updated 14 Jun 2016, 06:37 PM

Posted by Dixie5346
14 Jun 2016, 06:37 PM

Do you have the results of this clinical trial yet? If so, should we increase phosporous in the diet and which foods are best?

Posted by tieshiea
9 Apr 2015, 03:36 AM

Thanks. I appreciate your time. T

Posted by LadaBL
9 Apr 2015, 02:30 AM

Great! Thanks for reaching out. I did not hear from the research coordinators but will ask. I'll email you. Lada

View Full Thread (3 more posts)
Dent's Conference 2016 Created by CaraM120
Last updated 6 Jun 2016, 03:43 PM

Posted by CaraM120
6 Jun 2016, 03:43 PM

Is there going to be a conference this year? I haven't heard anything yet, and last year they started talking about it around march or april.

Dent's conference 2015 Created by CaraM120
Last updated 12 Oct 2015, 02:06 PM

Posted by LadaBL
12 Oct 2015, 02:06 PM

I'm glad it worked! How was it? Lada

Posted by minu
11 Oct 2015, 01:37 PM

Worked when you started talking, Lada! Hope to see Jay's talk in video later. Thanks so much!

Posted by LadaBL
10 Oct 2015, 03:35 PM

Is it working now?

View Full Thread (2 more posts)
Dent Asociation Created by EvaK
Last updated 12 Apr 2015, 02:17 PM

Posted by EvaK
12 Apr 2015, 02:17 PM

Hi all, I have response from Asdent, they are already in contact with Mayo Clínic, so I hope your collaboration will be great for both. Big hug

Posted by LadaBL
9 Apr 2015, 02:33 AM

Thanks as always! Hope to see you in NY in October!

Posted by minu
7 Apr 2015, 04:17 AM

And again, Lada, if you need any translating or interpreting between Spanish and English please feel free to use me any time. Daniel should be somewhat able to help too.

View Full Thread (11 more posts)
Growth Created by Vicky_p
Last updated 8 Apr 2015, 06:27 AM

Posted by tieshiea
8 Apr 2015, 06:27 AM

My son Zander was dx with dents at 5 yrs. Now is 10.5 yrs. He is 4 ft tall my side.of family 8s short stature. His dad however.is 6ft 8 inch. We started endocrinology and the hand xray. Awaiting MD to get back to me from Stanford University. He had been seen at Stanford for 5 yrs now and luckily dr.potter there was able to dx him early and her him on chlorthalidone. (Sp) which he has been on since.but with varying dosages. He is also skinny. His wt is 56 lbs finally and that has taken 3 yrs to get there. As far as po4 he takes 750mg bid. Neutral phos. 2000 units.vit d just restarted that last 3.months. daily. 80 me kcl 30 20 30 dose during day to combat chlorthaladone k wasting. Avg. K level is 3.3-3.5. Lab about every 3 months. Also takes a milo ride to kick up his k levels. I have Zander in the study, or at least I returned the papers and hopes his data helps research. My concern is the obvious future kid. Failure, and transplant if and when it comes to that for him, but his overall fitting in. Being so short does not help in school. To make learning an issue he.was a.late talker 3 years old to make a 5 word sentence. Now he won't shut it. But he has adhd, and that lack of concentration and taking care of his disease in his future worries me. He is well aware of all his med and the rationale for their continued use and dose changes. It seems as if.from reading other posts the correlation of growth and learning is a factor is this disease process. Zander mom T

Posted by LadaBL
22 Jan 2015, 01:37 PM

I have the hypothesis that possibly Dent and Lowe patients don't get enough phosphorus in their bone as they hit the potential growth spurt (because they lose some through their kidney). One way to prove that is to show that the major hormone that causes release of phosphorus in the urine is below normal in Dent. So far 3/4 adult Dent patients in my study have it. Now I want to see if children (in particular) children in puberty have that as well. Growth hormone also increases phosphorus absorption in the kidney, and it's possible that that is the way it works. We don't know which effect it has on the bone of Dent kids. Lada

Posted by hamilt1
21 Jan 2015, 11:59 PM

I have three children, one with Dent's. Both of my two children without Dent's are tall...medium to extra large framed. My son with Dent's is thin, small framed, and definetly grew at a different rate. For a frame of reference, my 12 year old is 5'10 and 170 pounds. My 15 year old with Dent's is 5'6 and 110 pounds. My son also had sensory processing disorder.

View Full Thread (15 more posts)
Community Resources
Title Description Date Link
Dent Registry

I am happy to inform everyone that Dent Registry is started at Mayo clinic. We hop that we can gather more information and advance knowledge on the disease and therapy.

 

We are looking to enrol all patients with Dent all over the world. If you are interested, please check out our website. Please feel free to ask any questions.

 

 

Lada

03/20/2017

Clinical Trials


Cords registry

CoRDS, or the Coordination of Rare Diseases at Sanford, is based at Sanford Research in Sioux Falls, South Dakota. It provides researchers with a centralized, international patient registry for all rare diseases. This program allows patients and researchers to connect as easily as possible to help advance treatments and cures for rare diseases. The CoRDS team works with patient advocacy groups, individuals and researchers to help in the advancement of research in over 7,000 rare diseases. The registry is free for patients to enroll and researchers to access.

Enrolling is easy.

  1. Complete the screening form.
  2. Review the informed consent.
  3. Answer the permission and data sharing questions.

After these steps, the enrollment process is complete. All other questions are voluntary. However, these questions are important to patients and their families to create awareness as well as to researchers to study rare diseases. This is why we ask our participants to update their information annually or anytime changes to their information occur.

Researchers can contact CoRDS to determine if the registry contains participants with the rare disease they are researching. If the researcher determines there is a sufficient number of participants or data on the rare disease of interest within the registry, the researcher can apply for access. Upon approval from the CoRDS Scientific Advisory Board, CoRDS staff will reach out to participants on behalf of the researcher. It is then up to the participant to determine if they would like to join the study.

Visit sanfordresearch.org/CoRDS to enroll.

Community Leaders

LadaBL

Hi,

 

 

I am a nephrologist (kidney doctor) who works at NYU in New York City. National Institutes of Health has sponsored research of Dent disease starting Sept 2009 which includes, and starts with, forming Registry of Dent disease patients.

 

 

Dent disease manifests usually with low molecular weight proteinuria (loss of protein in the urine) and often with kidney stones or even calcifications of kidney. Significant number of patients develop kidney failure and need dialysis or transplantation.

 

 

Registry means collection of information on individual patients which is then stored, anonymously, in one database. That allows us to analyze collected information on large group of Dent patients, which has never been done before, because physicians typically take care of only few Dent patients (usually 1-5).

 

 

Our website is http://www.rarekidneystones.org/dent, where you can look up the available information.

 

 

Contact:

 

Barb Seide| Study Coordinator | Mayo Clinic Hyperoxaluria Center | Nephrology Research | Phone: 507-293-4112 | 800-270-4637 | fax: 507-255-0770 | seide.barbara@mayo.edu | hyperoxaluriacenter@mayo.edu.

 

 

I would be happy to answer any of your questions. My email is lada.bearalasic@nyumc.org or LadaBL@yahoo.com.

 

 

Several people from this site have contacted us. Congratulations for making the initiative and moving the knowledge forward!

 

 

 

Stay strong!

 

 

Lada

 

 

 

Expert Questions

Ask a question

54321 Message
22 Jan 2014, 08:46 PM

Hi Lada

 

My son Dan ( now 22)has now graduated University and his next move is to Israel where he intends to live for a while. 'Just in case' he has a problem like he had while in the US do you know of any experts/ clinics there he can make contact with to make sure he has regular check ups. After the rather disastrous fall in kidney function while in the US after self medicating his tonsillitis with Ibuprofen his function has stabilised at 44% and he is otherwise in very good health.

 

Debbie Birrell (UK)

Answer

Hi Debbie,

 

 

I have contacted Dr Yaacov Frishberg who is a Dent expert. Although he is a pediatrician, he said he would be happy to see your son.

 

 

Below is his contact information.

 

 

Best of luck!

 

 

Lada

 

 

 

Prof Yaacov Frishberg, MD

 

 

Director, Division of Pediatric Nephrology

 

 

Shaare Zedek Medical Center

 

 

P.O.Box 3235

 

 

Jerusalem 91031

 

 

ISRAEL

 

 

Tel: 972 2 6666144

 

 

Fax: 972 2 6555484

 

 

CaraM120 Message
13 Jun 2013, 02:13 PM

My son was recently diagnosed with Dents, and was put on enalapril and the medicine has had no effect on him. His pediatric nephrologist, this is the first case of Dents he has actually seen, so he does not know how to treat this. I see other pts on the site, and they are on several different types of medications to control their symptoms, and I don't want him to be overlooked and more damage to be done by not being treated. I just don't know what our next step should be, and his nephrologist is just watching him and bringing him back every two months for blood work and urine check. I feel like maybe there is more that they should be doing for him.

Answer

Hi,

 

 

How old is your son?

 

Do you live anywhere near New York, Philadelphia or could you come to Mayo clinic?

 

 

In general, not many medications have been tested on Dent patients.

 

 

Thiazide diuretics have been shown to decrease urinary clacium, however they are often poorly tolerated in Dent patients, in particular children causing low blood pressure and dehydration as well as low potassium.

 

Citrates have been shown to decrease progression of kidney disease in rats (gene defect similar to Dent) and many patients take them or increase citrate in their diet (lemonade, orange juice).

 

 

We are currently doing a study evaluating role of phosphate supplements in Dent patients to lower urine calcium in safer way than thaizide diuretics, but they have to be older then 18 years old to get phosphate supplements.

 

 

For the younger patients, we will do all measurements of hormones important for the calcium and phosphorus metabolism, without giving phosphorus. You could do that remotely (not in any of our centers), if you bring 24h urine and get blood drawn in the local lab. This could help understand what is happening with your son better since we are doing tests not routinely done in private offices.

 

Let me know if you are interested.

 

 

Did you join our registry? You could contact us at rarekidneystones@mayo.edu| rarekidneystones.org.

 

 

We are also having a patient meeting in Chicago in June this year, meeting other parents and patients could be useful.

 

 

Many regards,

 

 

Lada

 

 

CaraM120 Message
10 May 2013, 04:17 PM

So happy to have stumbled upon this site. My seven year old son was just diagnosed with Dent's and this is the first case his nephrologist has ever seen. We are just trying to figure out how to go forward and the best possible treatment for him. Any advice would be great. Thanks!

Answer

Hi,

 

 

I think I have just answered you. Just in case, to repeat:

 

 

Do you live anywhere near New York, Philadelphia or could you come to Mayo clinic?

 

 

In general, not many medications have been tested on Dent patients.

 

 

Thiazide diuretics have been shown to decrease urinary clacium, however they are often poorly tolerated in Dent patients, in particular children causing low blood pressure and dehydration as well as low potassium.

 

Citrates have been shown to decrease progression of kidney disease in rats (gene defect similar to Dent) and many patients take them or increase citrate in their diet (lemonade, orange juice).

 

 

We are currently doing a study evaluating role of phosphate supplements in Dent patients to lower urine calcium in safer way than thaizide diuretics, but they have to be older then 18 years old to get phosphate supplements.

 

 

For the younger patients, we will do all measurements of hormones important for the calcium and phosphorus metabolism, without giving phosphorus. You could do that remotely (not in any of our centers), if you bring 24h urine and get blood drawn in the local lab. This could help understand what is happening with your son better since we are doing tests not routinely done in private offices.

 

Let me know if you are interested.

 

 

Did you join our registry? You could contact us at rarekidneystones@mayo.edu| rarekidneystones.org.

 

 

We are also having a patient meeting in Chicago in June this year, meeting other parents and patients could be useful.

 

 

Many regards,

 

 

Lada

 

 

Dixie5346 Message
14 Jun 2012, 09:17 PM

I was wondering why both of my sons' had problems with potassium loss while their kidneys were chronically failing? It is my understanding that most kidney failure patients have the opposite effect. Is this something that presents with Dent Disease?

Answer

Yes, Dent disease specifically has damaged proximal tubules, section of the kidney important for re-absorption of several important molecules, including potassium. That's why sometimes in Dent disease you can have low potassium. As the kidney failure progresses, that could be reversed as kidney in the whole fails to excrete potassium.

54321 Message
20 Jan 2012, 08:03 PM

Lada

 

Excuse me if I've asked this elsewhere - not sure if I pressed the right button.

 

My 20 year old son has Dents and came home I'll with tonsilitis and Glandular fever from SFSU . He's had a biopsy and bloods and CAR scan and the doc is satisfied the drop in function from 78+ to 46 is due to the throat problems and ibuprofen causing kidney inflammation. He has prescribed Steroids(prednisone ) but wants him monitored in SF on his return . Can you recommend a nephrologist - he will have a very full letter from our Doc and will only be there fromJan 28 to early May when he returns to the UK.

Answer

Same confusion here!

 

Please see my answer in discussion forum.

 

 

Lada

54321 Message
20 Jan 2012, 12:31 PM

I've set out my family situation on another post. My son is doing his third year of a 4 year degree at SFSU. When he came home for Christmas he had glandular fever and tonsilitis. He had been taking ibuprofen. His kidney function had fallen from78% to 46%. A biopsy has been carried out and the pathologist and doc are satisfied the inflammation and results have been caused by the throat problemsand/or ibuprofen. They are prescribing steroids to reduce the inflammation but say he will need monitoring- blood tests presumably to see if the steroids are working and when they can be reduced. Do you know of a nephrologist who can do this in San Francisco or the Bay Area. Otherwise I'll just have to google names which is not ideal!

Answer

Debra,

 

 

Please look in the discussion forum, I have not noticed the question until now.

 

 

I wish Dan fast recovery.

 

 

Lada

vistaonly Message
27 Nov 2011, 07:07 AM

kari,

 

 

My son has dents disease. We go to

 

Stephanie Jernigan, Dunwoody pediatrics. She is very knowledgeble and good. This is in atlanta, GA. Not too far from chattanooga.

Answer

Thank you very much for the information.

pscoop Message
14 Mar 2011, 11:11 PM

Hi Lada, amazing to find this site. Thank you so much. Will be registering on the site address you have given. Paul

Answer

Thank you Paul, this is great!

 

Did you see Dr. Thakker?

 

I'll let Barbara know that you'll contact her.

 

 

Lada

kari Message
6 Mar 2011, 11:38 PM

Hey Lada, was hoping you might know of a pediatric nephrologist in or near Chattanooga TN. We are having a hardtime finding a doctor to help us. my 15 yr old son has Dents, severe osteoporsis, and sever ichtheosis, among several other battles he is going through. i appreciate any help you could give me.

Answer

Hi,

 

 

I don't know anybody with specific interest in Dent disease but I did find a name of pediatric nephrologist who was highly recommended from Mayo clinic.

 

This is her contact information:

 

 

 

Dr. Kathy Jabs

 

Director, Pediatric Nephrology

 

Vanderbilt University

 

3601 Tvc

 

Nashville, TN 37232

 

(615) 322-3000

 

 

Let me know if it helps.

 

 

Lada

 

kjsjd Message
25 Jan 2011, 11:06 PM

Hi Lada

 

I'm in the UK and we've just had the genetic testing back positive for Dents1 for my 8 (almost 9) year old son. It is great to find this site and I've read some of the discussion strands. We've been through the unresponsive to oral pred route after first presentation, the ACEIs which dropped his PCR from 400+ to 250 ish initially before some rebound, adding in an ARB and more recently trying oral tacrolimus for 9months as his first renal biopsy aged 5 suggested FSGS. The tac intriguingly dropped his PCR to below 200 for the first time, but his creatinine started increasing and as we weren't obtaining maximal results we agreed to stop it. He is currently on an ACEI only and we are considering options - I'm not keen on thiazides due to s/e (and not only that but the poor little man still has nocturnal enuresis) and I try and get him to drink as much citrus juice as possible (interestingly he loves sucking lemons as he says they make him feel better!). My concern is his growth; I haven't found any medical articles specifically relating to Dents and poor growth, although I have seen several anecdotal comments regarding this on your site. His growth has been pretty much static for the last 2 years and he has dropped from the 95th centile at birth off the bottom now! What is your experience of this and do you have any research/papers you can point me towards. Otherwise my son is great - a real character. In case you were wondering, I'm a GP in the UK and I picked his proteinuria up (whilst he was entirely well) as I noted his frothy urine one day when he forgot to flush the toilet!

Answer

Hi, it has not been uncommon for a child with Dent disease to be treated with immunosupressive therapy before the right diagnosis is made.

 

 

Our common goal is to increase awareness of Dent disease and improve accuracy of diagnosis, because Dent patients are out there. Interestingly, adults get diagnosed much less, usually in retrospect once a child who is a grandchild is diagnosed.

 

 

I have read about growth delay in Dent.

 

Look at this article from J Pediatr Endocrinol Metab. 2008 Mar;21(3):279-86.

 

 

Summary:

 

Dent disease, an X-linked recessive renal tubular disease, results from loss-of-function mutations in the CLCN5 chloride channel gene. The effects of Dent disease on growth have not been described. We report siblings who presented with proteinuria, calciuria, and phosphaturia and growth failure who responded to growth hormone (GH) treatment. Genotyping revealed a novel c.2179delG frameshift mutation at codon 727, exon 12 of the CLCNS gene. Two years after initial presentation, linear growth had slowed, and evaluation revealed isolated GH deficiency. GH therapy resulted in more than two-fold increases in height velocity and serum IGF-I levels. There was no net change in estimated glomerular filtration rate, proteinuria or calciuria in response to GH therapy, but there was a delayed improvement in phosphaturia. These cases provide insight into the effects of GH on growth and renal function in Dent disease. Furthermore, we have reported a novel CLCN5 mutation.

 

 

 

 

We are trying to establish a patient advocacy group. Because patients are so far apart, somebody suggested to me that teleconferencing for meetings.

 

 

We would also like to collect de-identified information on Dent patients and put it together in registry, to be able to observe clinical course (like growth delay) and if and how different medications can have long term effect.

 

Would you be interested?

 

 

It is good to hear from Dent families. I hope I can help.

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Hi,

 

 

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