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Human Genetics
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Patients with Mutations in NPHS2 (Podocin) Do Not Respond to Standard Steroid Treatment of Nephrotic Syndrome

Rainer G. Ruf, Anne Lichtenberger, Stephanie M. Karle, Johannes P. Haas, Franzisco E. Anacleto, Michael Schultheiss, Isabella Zalewski, Anita Imm, Eva-Maria Ruf, Bettina Mucha, Arvind Bagga, Thomas Neuhaus, Arno Fuchshuber, Aysin Bakkaloglu, Friedhelm Hildebrandt and the Arbeitsgemeinschaft für Pädiatrische Nephrologie Study Group
JASN March 2004, 15 (3) 722-732; DOI: https://doi.org/10.1097/01.ASN.0000113552.59155.72
Rainer G. Ruf
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Anne Lichtenberger
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Stephanie M. Karle
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Johannes P. Haas
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Franzisco E. Anacleto
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Michael Schultheiss
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Isabella Zalewski
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Anita Imm
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Eva-Maria Ruf
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Bettina Mucha
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Arvind Bagga
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Thomas Neuhaus
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Arno Fuchshuber
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Aysin Bakkaloglu
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Friedhelm Hildebrandt
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    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

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  • Table 1. Clinical data for patients with mutations and sequence variations in NPHS2a

    GroupFamily-IndividualGenderMutation (Amino Acid Exchange)Age of Onset (yr)Initial SymptomsBiopsySteroid TherapyCP/CsA TherapyESRD (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)).
    A236-1bFG413A/R138Q (H)2.5ASFSGSSRNDY (11.4)Y (13.5)N (3.7)
    A260-1bMG413A/R138Q (H)4.3AS?SRCP (N)Y (4.9)Y (5.0)N (10)
    A260-2bMG413A/R138Q (H)1.0AS?SRCP (N)Y (7.2)Y (8.6)N (10)
    A330-1bFG686A/R229Q (h)-C871T/R291W (h)3.5?FSGSSRCsA (P)Y (21.2)NN
    A330-2bMG686A/R229Q (h)-C871T/R291W (h)3.0ASFSGSSRNDY (14.8)Y (17.7)AR (0.0)
    A348-1bMG413A/R138Q (H)3.3ASFSGSSRNDN
    A348-2bMG413A/R138Q (H)2.0ASFSGSSRNDY (?)Y (13, 36)CR (22.0)
    A370-1bMG686A/R229Q (h)-C851T/A284V (h)24.0P-ASFSGSSRCsA + CP (N)N (3)NN
    A370-2bFG686A/R229Q (h)-C851T/A284V (h)9.0P-ASFSGSSRNDN (8.0)NN
    A398-1bFG413A/R138Q (H)2.8ASFSGSSRCsA (N)Y (2.6)Y (3.3)N (6.7)
    A460-1bFG413A/R138Q (H)2.5ASMCNSNDNDY (8.5)Y (9.7)N (2.9)
    A460-2bMG413A/R138Q (H)5.4ASMCNSSRCP (N)Y (5.7)Y (6.4)N (6.4)
    A489-1bMG686A/R229Q (h)-C851T/A284V (h)11.8ASFSGSSRCsA (N)N (4.4)NN
    A489-2bFG686A/R229Q (h)-C851T/A284V (h)3.5ASFSGSSRCsA (N)Y (7.1)NN
    A747-1bMG413A/R138Q (H)1.8ASFSGSSRNDY (2.0)Y (3.1)N (3.7)
    A747-2bMG413A/R138Q (H)3.8ASFSGSSRCsA (P)N (2.0)NN
    A763bFG538A/V180M (H)16.6ASFSGSSRCsA (?)Y (3.5)NN
    A764bFG413A/R138Q (H)?ASMCNSSRCsA (P)Y (?)NN
    A789bMIVS4-1G>T (H)5.0ASFSGSSRCsA (?)N (0.5)NN
    A803bFC851T/A284V (H)2.0ASFSGSSRNDY (8.0)Y (8.8)N (1.1)
    A833bFdel AA 855/56/S302X (H)9.1ASMCNSSRCsA + CP (N)Y (1.6)Y (3.4)N (7.7)
    A836bFG587C/R196P (h)-G868A/V290M (h)1.3ASFSGSSRCsA (N)N (10.1)NN
    A861FG868A-V290M(h)-del T 948/L347X (h)2.2P-ASFSGSSRCsA (P)N (13.8)NN
    A873MG770A/G257E(H)0.3P-ASMCNSNDNDN (0.5)NN
    A888MG413A/R138Q (h)-IVS7+2T>A (h)3.5ASFSGSSR?N (1.4)NN
    A911FG686A/R229Q (h)-A929T/E310V (h)4.0ASFSGSSRCsA (N), CP (N)Y (7.9)Y (8.3)N (1.5)
    A975-1MG413A/R138Q (H)4.3ASFSGSSRCP (N)Y (1.5)Y (4.1)N (5.7)
    A975-2MG413A/R138Q (H)1.5ASFSGSSRNDY (9.7)N
    A1005FG413A/R138Q (h)-IVS3+2T>A (h)3.4ASMCNSSRCsA (N)Y (4.0)Y (7.8)N (1.5)
    A1006MG413A/R138Q (h)-G503A/R168H (h)4.9?FSGSSR?Y (6.2)Y (8.5)N (3.4)
    A1023MG413A/R138Q (h)-ins T 460–467/V165X (h)1.5ASFSGSSRCsA (N)Y (6.0)Y (7.5)N (4.3)
    A1030FG413A/R138Q (H)0.7ASFSGSSRCP (N)Y (9.3)Y (13.1, 19.1)N (CR6, ?)
    A1032FG413A/R138Q (h)-G868A/V290M (h)11.0PIgMNDNDN (2.7)NN
    A1033MG413A/R138Q (H)0.5ASNDNDNDN (1.2)NN
    A1041Fins A 29/E69X (h)-G304A/E102K (h)2.2ASMPSRCP (N)N (2.5)NN
    A1045Mins T 460–467/V165X (H)1.0ASFSGSSRCsA (N)Y (9.0)NN
    A1059-1MC353T/P118L (H)2.0ASFSGSSRNDY (4.4)NN
    A1069MG686A/R229Q (H)7.4ASFSGS?CP (N)Y (5.8)NN
    A1077MT803G/V268G (H)3.5ASFSGSSRCP (N)N (0.5)NN
    A1083FC353T/P118L (H)3.6ASDMSSRCP (N)Y (1.5)NN
    A1139Fdel T 948/L347X (H)0.7ASFSGSSRCsA (N)Y (3.2)Y (3.6)Y (0.1)
    A1173MG686A/R229Q (H)5.5ASFSGSSRCsA (N), CP (N)N (3.1)NN
    B236-2bMG413A/R138Q (H)0.1ASFSGSSRNDY (9.4)Y (10.4)N (6.7)
    B355-1bMG413A/R138Q (h)-ins T 460–467/V165X (h)0.0ASFSGSSRCsA (N)Y (5.7)Y (6.2)N (1.6)
    B355-2bFG413A/R138Q (h)-ins T 460–467/V165X (h)0.0ASFSGSNDNDN (4.0)NN
    B398-2bFG413A/R138Q (H)0.0ASFSGSSRCsA (N)Y (4.2)Y (5.0)N (3.0)
    B515-1bMG413A/R138Q (h)-419 del G/V180X (h)0.0ASCNSSRNDY (?)Y (7.8)N (9.0)
    B515-2bFG413A/R138Q (h)-419 del G/V180X (h)0.0ASNDSRNDY (?)Y (14.5)N (0.4)
    B859bMG413A/R138Q (H)0.0PMCNSSRCsA (P)N (3.3)NN
    B935Mins T 460–467/V165X (h)-T506C/L169P (h)0.0ASMCNSSRNDN (1)NN
    B942-1MG413A/R138Q (h)-G503A/R168H (h)0.0???????
    B942-2MG413A/R138Q (h)-G503A/R168H (h)0.0???????
    B1028MC353T P118L (h)-G413A/R138Q (h)0.0ASMPNDNDN (6.4)NN
    B1201Mins T 460–467/V165X (h)-C871T/R291W (h)0.0PFSGSSRCsA (N)N (7.3)NN
    B1221MG378T/K126N (h)-del T 948/L347X (h)0.0ASFSGSNDNDY (6.2)Y (6.6)Y (?)
    B1233FG413A/R138Q (h)-ins T 460–467/V165X (h)0.0ASFSGSSRNDN (2.9)NN
    C376-1bMG413A/R138Q (h)4.0ASFSGSSRCsA (P)Y (8.0)NN
    C376-2bMG413A/R138Q (h)7.0ASMCNSSRCsA (R)N (2.8)NN
    C923MA983G/Q328R (h)??ND?????
    C1086MG709C/E237Q (h)10.5ASMCNSSRCsA (R)NNN
    C1104FC725T/A242V (h)1.6ASFSGSSRCP (R)N (1.4)NN
    D3908MG709C/E237Q (h)5.7ASMCNSSSCsA (?)NNN
    D4286MC59T/P20L (h)?ASMCNSSSNDNNN
    D3147MG413A/R138Q (h)3.2ASNDSSNDNNN
    D1172FC871T/R291W (h)1.5ASFSGSSS-SRCsA (N)N (0.7)NN
  • 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

    GroupNo. 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 (%)ESRDMedian 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 alleles43/165 (26%)b56/190c2.0d (n = 54)37/8/5/6 (66/14/9/11)0/5/24 (0/17/83)33/56 (59%)10.0e6.02/24 (8%)
        absence of mutations118/165 (72%)f129/190g4.8h (n = 111)80/20/10/19 (62/16/8/14)12/14/38 (19/22/59)34/129 (26%)10.5i3.07/20 (35%)
        single heterozygous sequence variants4/165 (2%)5/1905.5 (n = 4)2/2/0/1 (40/40/0/20)3/1/0 (75/25/0)1/5 (20%)12.05.00/0 (0%)
        total of families/patients with SRNS165j190k3.5l (n = 169)115/34/14/27 (61/18/7/14)13/17/56 (15/20/65)68/190 (36%)10.1m5.28/44 (18%)
    SSNS
        mutations in both alleles0/120 (0%)0/124NANANANANANANA
        absence of mutations116/120 (97%)n120/124n4.4 (n = 99)25/20/7/68 (21/17/6/56)NA2/120NANANA
        single heterozygous sequence variants4/120 (3%)o4/124o3.2 (n = 3)1/2/0/1 (25/50/0/25)NANANANANA
        total of families/patients with SSNS1201244.4 (n = 102)26/22/7/69 (21/18/5/56)NA2/124NANANA
  • Table 3. Distribution of mutations and heterozygous sequence variants in NPHS2a

    Homozygous Families/PatientsCompound Heterozygous Families/PatientsHeterozygous Sequence Variant Families/Patients
    a CNS, congenital NS. Groups A to D correspond to Table 1.
    Group A + C, SRNS22/2712/154/5
    Group B, SRNS + CNS3/38/110
    Group D, SSNS004/4
    Healthy control subjects000
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Journal of the American Society of Nephrology: 15 (3)
Journal of the American Society of Nephrology
Vol. 15, Issue 3
1 Mar 2004
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Patients with Mutations in NPHS2 (Podocin) Do Not Respond to Standard Steroid Treatment of Nephrotic Syndrome
Rainer G. Ruf, Anne Lichtenberger, Stephanie M. Karle, Johannes P. Haas, Franzisco E. Anacleto, Michael Schultheiss, Isabella Zalewski, Anita Imm, Eva-Maria Ruf, Bettina Mucha, Arvind Bagga, Thomas Neuhaus, Arno Fuchshuber, Aysin Bakkaloglu, Friedhelm Hildebrandt, the Arbeitsgemeinschaft für Pädiatrische Nephrologie Study Group
JASN Mar 2004, 15 (3) 722-732; DOI: 10.1097/01.ASN.0000113552.59155.72

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Patients with Mutations in NPHS2 (Podocin) Do Not Respond to Standard Steroid Treatment of Nephrotic Syndrome
Rainer G. Ruf, Anne Lichtenberger, Stephanie M. Karle, Johannes P. Haas, Franzisco E. Anacleto, Michael Schultheiss, Isabella Zalewski, Anita Imm, Eva-Maria Ruf, Bettina Mucha, Arvind Bagga, Thomas Neuhaus, Arno Fuchshuber, Aysin Bakkaloglu, Friedhelm Hildebrandt, the Arbeitsgemeinschaft für Pädiatrische Nephrologie Study Group
JASN Mar 2004, 15 (3) 722-732; DOI: 10.1097/01.ASN.0000113552.59155.72
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