Article Figures & Data
Figures
Figure 1. NPHS2 mutations observed in 165 families with steroid-resistant nephrotic syndrome (SRNS). The schematic diagram depicts the eight NPHS2 exons. Missense mutations are indicated above the exon bar, as colored circles. The amino acid change in the podocin gene is indicated above the circles. Splice site and frameshift mutations are shown below the exon bar and are symbolized as colored bars, indicating the position of truncation. Mutations are color-coded; novel mutations not previously described are red, previously reported mutations observed again in the 165 families with SRNS are orange, and mutations previously described by our group (14) are green. The frequencies of the different mutations observed among the 165 families with SRNS are indicated by the different numbers of circles. Each circle or bar is equivalent to one mutation observed among 165 families with SRNS, corresponding to the data presented in Table 1.
Tables
Table 1. Clinical data for patients with mutations and sequence variations in NPHS2a
Group Family-Individual Gender Mutation (Amino Acid Exchange) Age of Onset (yr) Initial Symptoms Biopsy Steroid Therapy CP/CsA Therapy ESRD (yr after Onset) KTx (yr after Onset) Relapse of FSGS after KTx a Group A, patients with steroid-resistant nephrotic syndrome (NS) (SRNS) and mutations in both alleles of NPHS2; P-AS, intermittent low-grade proteinuria progressing to acute NS; AR, acute rejection; AS, acute symptoms of NS; group B, patients with SRNS, mutations in both alleles of NPHS2, and CNS; group C, patients with SRNS and a single heterozygous sequence variant; CNS, histology of congenital NS; CP, cyclophosphamide; CR, chronic rejection; CsA, cyclosporine A; group D, patients with steroid-sensitive NS (SSNS) and a single heterozygous sequence variant; DMS, diffuse mesangial sclerosis; (h), heterozygous; (H) homozygous; IgM, IgM nephropathy; KTx, kidney transplantation; MCNS, minimal-change glomerulonephritis; MP, mesangioproliferative glomerulonephritis; N, no; (N), no remission; ND, not done; P, intermittent low grade-proteinuria; (P), partial remission; (R), complete remission; SS, steroid-sensitive; SS-SR, steroid-sensitive progressing to steroid-resistant; SR, steroid-resistant; Y, yes; ?, no data. b Mutations for these patients were previously reported ((14)). A 236-1b F G413A/R138Q (H) 2.5 AS FSGS SR ND Y (11.4) Y (13.5) N (3.7) A 260-1b M G413A/R138Q (H) 4.3 AS ? SR CP (N) Y (4.9) Y (5.0) N (10) A 260-2b M G413A/R138Q (H) 1.0 AS ? SR CP (N) Y (7.2) Y (8.6) N (10) A 330-1b F G686A/R229Q (h)-C871T/R291W (h) 3.5 ? FSGS SR CsA (P) Y (21.2) N N A 330-2b M G686A/R229Q (h)-C871T/R291W (h) 3.0 AS FSGS SR ND Y (14.8) Y (17.7) AR (0.0) A 348-1b M G413A/R138Q (H) 3.3 AS FSGS SR ND N A 348-2b M G413A/R138Q (H) 2.0 AS FSGS SR ND Y (?) Y (13, 36) CR (22.0) A 370-1b M G686A/R229Q (h)-C851T/A284V (h) 24.0 P-AS FSGS SR CsA + CP (N) N (3) N N A 370-2b F G686A/R229Q (h)-C851T/A284V (h) 9.0 P-AS FSGS SR ND N (8.0) N N A 398-1b F G413A/R138Q (H) 2.8 AS FSGS SR CsA (N) Y (2.6) Y (3.3) N (6.7) A 460-1b F G413A/R138Q (H) 2.5 AS MCNS ND ND Y (8.5) Y (9.7) N (2.9) A 460-2b M G413A/R138Q (H) 5.4 AS MCNS SR CP (N) Y (5.7) Y (6.4) N (6.4) A 489-1b M G686A/R229Q (h)-C851T/A284V (h) 11.8 AS FSGS SR CsA (N) N (4.4) N N A 489-2b F G686A/R229Q (h)-C851T/A284V (h) 3.5 AS FSGS SR CsA (N) Y (7.1) N N A 747-1b M G413A/R138Q (H) 1.8 AS FSGS SR ND Y (2.0) Y (3.1) N (3.7) A 747-2b M G413A/R138Q (H) 3.8 AS FSGS SR CsA (P) N (2.0) N N A 763b F G538A/V180M (H) 16.6 AS FSGS SR CsA (?) Y (3.5) N N A 764b F G413A/R138Q (H) ? AS MCNS SR CsA (P) Y (?) N N A 789b M IVS4-1G>T (H) 5.0 AS FSGS SR CsA (?) N (0.5) N N A 803b F C851T/A284V (H) 2.0 AS FSGS SR ND Y (8.0) Y (8.8) N (1.1) A 833b F del AA 855/56/S302X (H) 9.1 AS MCNS SR CsA + CP (N) Y (1.6) Y (3.4) N (7.7) A 836b F G587C/R196P (h)-G868A/V290M (h) 1.3 AS FSGS SR CsA (N) N (10.1) N N A 861 F G868A-V290M(h)-del T 948/L347X (h) 2.2 P-AS FSGS SR CsA (P) N (13.8) N N A 873 M G770A/G257E(H) 0.3 P-AS MCNS ND ND N (0.5) N N A 888 M G413A/R138Q (h)-IVS7+2T>A (h) 3.5 AS FSGS SR ? N (1.4) N N A 911 F G686A/R229Q (h)-A929T/E310V (h) 4.0 AS FSGS SR CsA (N), CP (N) Y (7.9) Y (8.3) N (1.5) A 975-1 M G413A/R138Q (H) 4.3 AS FSGS SR CP (N) Y (1.5) Y (4.1) N (5.7) A 975-2 M G413A/R138Q (H) 1.5 AS FSGS SR ND Y (9.7) N A 1005 F G413A/R138Q (h)-IVS3+2T>A (h) 3.4 AS MCNS SR CsA (N) Y (4.0) Y (7.8) N (1.5) A 1006 M G413A/R138Q (h)-G503A/R168H (h) 4.9 ? FSGS SR ? Y (6.2) Y (8.5) N (3.4) A 1023 M G413A/R138Q (h)-ins T 460–467/V165X (h) 1.5 AS FSGS SR CsA (N) Y (6.0) Y (7.5) N (4.3) A 1030 F G413A/R138Q (H) 0.7 AS FSGS SR CP (N) Y (9.3) Y (13.1, 19.1) N (CR6, ?) A 1032 F G413A/R138Q (h)-G868A/V290M (h) 11.0 P IgM ND ND N (2.7) N N A 1033 M G413A/R138Q (H) 0.5 AS ND ND ND N (1.2) N N A 1041 F ins A 29/E69X (h)-G304A/E102K (h) 2.2 AS MP SR CP (N) N (2.5) N N A 1045 M ins T 460–467/V165X (H) 1.0 AS FSGS SR CsA (N) Y (9.0) N N A 1059-1 M C353T/P118L (H) 2.0 AS FSGS SR ND Y (4.4) N N A 1069 M G686A/R229Q (H) 7.4 AS FSGS ? CP (N) Y (5.8) N N A 1077 M T803G/V268G (H) 3.5 AS FSGS SR CP (N) N (0.5) N N A 1083 F C353T/P118L (H) 3.6 AS DMS SR CP (N) Y (1.5) N N A 1139 F del T 948/L347X (H) 0.7 AS FSGS SR CsA (N) Y (3.2) Y (3.6) Y (0.1) A 1173 M G686A/R229Q (H) 5.5 AS FSGS SR CsA (N), CP (N) N (3.1) N N B 236-2b M G413A/R138Q (H) 0.1 AS FSGS SR ND Y (9.4) Y (10.4) N (6.7) B 355-1b M G413A/R138Q (h)-ins T 460–467/V165X (h) 0.0 AS FSGS SR CsA (N) Y (5.7) Y (6.2) N (1.6) B 355-2b F G413A/R138Q (h)-ins T 460–467/V165X (h) 0.0 AS FSGS ND ND N (4.0) N N B 398-2b F G413A/R138Q (H) 0.0 AS FSGS SR CsA (N) Y (4.2) Y (5.0) N (3.0) B 515-1b M G413A/R138Q (h)-419 del G/V180X (h) 0.0 AS CNS SR ND Y (?) Y (7.8) N (9.0) B 515-2b F G413A/R138Q (h)-419 del G/V180X (h) 0.0 AS ND SR ND Y (?) Y (14.5) N (0.4) B 859b M G413A/R138Q (H) 0.0 P MCNS SR CsA (P) N (3.3) N N B 935 M ins T 460–467/V165X (h)-T506C/L169P (h) 0.0 AS MCNS SR ND N (1) N N B 942-1 M G413A/R138Q (h)-G503A/R168H (h) 0.0 ? ? ? ? ? ? ? B 942-2 M G413A/R138Q (h)-G503A/R168H (h) 0.0 ? ? ? ? ? ? ? B 1028 M C353T P118L (h)-G413A/R138Q (h) 0.0 AS MP ND ND N (6.4) N N B 1201 M ins T 460–467/V165X (h)-C871T/R291W (h) 0.0 P FSGS SR CsA (N) N (7.3) N N B 1221 M G378T/K126N (h)-del T 948/L347X (h) 0.0 AS FSGS ND ND Y (6.2) Y (6.6) Y (?) B 1233 F G413A/R138Q (h)-ins T 460–467/V165X (h) 0.0 AS FSGS SR ND N (2.9) N N C 376-1b M G413A/R138Q (h) 4.0 AS FSGS SR CsA (P) Y (8.0) N N C 376-2b M G413A/R138Q (h) 7.0 AS MCNS SR CsA (R) N (2.8) N N C 923 M A983G/Q328R (h) ? ? ND ? ? ? ? ? C 1086 M G709C/E237Q (h) 10.5 AS MCNS SR CsA (R) N N N C 1104 F C725T/A242V (h) 1.6 AS FSGS SR CP (R) N (1.4) N N D 3908 M G709C/E237Q (h) 5.7 AS MCNS SS CsA (?) N N N D 4286 M C59T/P20L (h) ? AS MCNS SS ND N N N D 3147 M G413A/R138Q (h) 3.2 AS ND SS ND N N N D 1172 F C871T/R291W (h) 1.5 AS FSGS SS-SR CsA (N) N (0.7) N N Table 2. Clinical data and NPHS2 mutational analysis data for 190 patients with SRNS from 165 different families and 124 patients with SSNS from 120 different familiesa
Group No. of Families (% of Total Families) No. of Patients (Including Siblings) Median Age of Onset of NS (yr) Biopsy FSGS/MCNS/Other/ND (%) CR/PR/NR after Treatment with CP/CsA (%) ESRD Median Age at ESRD (yr) ESRD (yr after Onset) Relapse of FSGS after KTX a CNS, congenital NS; MCNS, minimal-change NS; KTX, kidney transplantation; CR, complete response; PR, partial response; NR, no response; NA, not applicable. b Eleven of 43 families presented with congenital NS. c Fourteen of 56 patients presented with congenital NS. d Median was 3.4 yr after exclusion of the 14 patients with congenital NS. e Median was 10.0 yr after exclusion of the patients with congenital NS and ESRD. f Six of 118 families presented with congenital NS, of which five showed mutations in NPHS1 on both alleles. g Eight of 129 patients presented with congenital NS, of whom seven showed mutations in NPHS1 on both alleles. h Median was 5.0 yr after exclusion of the eight patients with congenital NS. i Median was 11.5 yr after exclusion of the patients with congenital NS and ESRD. j Seventeen of 165 families presented with congenital NS. k Twenty-one of 190 patients presented with congenital NS. l Median was 4.0 yr after substraction of the 21 patients with congenital NS. m Median was 10.7 yr after substraction of the CNS patients with congenital NS and ESRD. n At least seven patients developed secondary steroid resistance in the clinical course of SSNS. o At least one patient developed secondary steroid resistance in the clinical course of SSNS. SRNS mutations in both alleles 43/165 (26%)b 56/190c 2.0d (n = 54) 37/8/5/6 (66/14/9/11) 0/5/24 (0/17/83) 33/56 (59%) 10.0e 6.0 2/24 (8%) absence of mutations 118/165 (72%)f 129/190g 4.8h (n = 111) 80/20/10/19 (62/16/8/14) 12/14/38 (19/22/59) 34/129 (26%) 10.5i 3.0 7/20 (35%) single heterozygous sequence variants 4/165 (2%) 5/190 5.5 (n = 4) 2/2/0/1 (40/40/0/20) 3/1/0 (75/25/0) 1/5 (20%) 12.0 5.0 0/0 (0%) total of families/patients with SRNS 165j 190k 3.5l (n = 169) 115/34/14/27 (61/18/7/14) 13/17/56 (15/20/65) 68/190 (36%) 10.1m 5.2 8/44 (18%) SSNS mutations in both alleles 0/120 (0%) 0/124 NA NA NA NA NA NA NA absence of mutations 116/120 (97%)n 120/124n 4.4 (n = 99) 25/20/7/68 (21/17/6/56) NA 2/120 NA NA NA single heterozygous sequence variants 4/120 (3%)o 4/124o 3.2 (n = 3) 1/2/0/1 (25/50/0/25) NA NA NA NA NA total of families/patients with SSNS 120 124 4.4 (n = 102) 26/22/7/69 (21/18/5/56) NA 2/124 NA NA NA Table 3. Distribution of mutations and heterozygous sequence variants in NPHS2a
Homozygous Families/Patients Compound Heterozygous Families/Patients Heterozygous Sequence Variant Families/Patients a CNS, congenital NS. Groups A to D correspond to Table 1. Group A + C, SRNS 22/27 12/15 4/5 Group B, SRNS + CNS 3/3 8/11 0 Group D, SSNS 0 0 4/4 Healthy control subjects 0 0 0