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| 2007 JASN IMPACT FACTOR 7.111 | HOME AUTHOR INFO EDITORIAL BOARD SUBSCRIBE FEEDBACK ALERTS HELP | |||
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e L. San Millán
*Division of Nephrology and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota; Renal Unit, The Oxford Radcliffe Hospital, Oxford, United Kingdom; Unidad de Genética Molecular, Hospital Ramón y Cajal, Madrid, Spain; ¶Institute für Human Genetik, Universitütsklinikum der RWTH Aachen, Aachen, Germany; |Institute of Child Health, London, United Kingdom; #Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey.
Correspondence to: Dr. Peter C. Harris, 760 Stabile Building, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Phone: 507-266-0541; Fax: 507-266-4071; E-mail: harris.peter{at}mayo.edu
ABSTRACT. The severity of renal cystic disease in the major form of autosomal dominant polycystic kidney disease (PKD1) is highly variable. Clinical data was analyzed from 324 mutation-characterized PKD1 patients (80 families) to document factors associated with the renal outcome. The mean age to end-stage renal disease (ESRD) was 54 yr, with no significant difference between men and women and no association with the angiotensin-converting enzyme polymorphism. Considerable intrafamilial variability was observed, reflecting the influences of genetic modifiers and environmental factors. However, significant differences in outcome were also found among families, with rare examples of unusually late-onset PKD1. Possible phenotype/genotype correlations were evaluated by estimating the effects of covariants on the time to ESRD using proportional hazards models. In the total population, the location of the mutation (in relation to the median position; nucleotide 7812), but not the type, was associated with the age at onset of ESRD. Patients with mutations in the 5' region had significantly more severe disease than the 3' group; median time to ESRD was 53 and 56 yr, respectively (P = 0.025), with less than half the chance of adequate renal function at 60 yr (18.9% and 39.7%, respectively). This study has shown that the position of the PKD1 mutation is significantly associated with earlier ESRD and questions whether PKD1 mutations simply inactivate all products of the gene.
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