PT  - JOURNAL ARTICLE
AU  - Giglio, Sabrina
AU  - Provenzano, Aldesia
AU  - Mazzinghi, Benedetta
AU  - Becherucci, Francesca
AU  - Giunti, Laura
AU  - Sansavini, Giulia
AU  - Ravaglia, Fiammetta
AU  - Roperto, Rosa Maria
AU  - Farsetti, Silvia
AU  - Benetti, Elisa
AU  - Rotondi, Mario
AU  - Murer, Luisa
AU  - Lazzeri, Elena
AU  - Lasagni, Laura
AU  - Materassi, Marco
AU  - Romagnani, Paola
TI  - Heterogeneous Genetic Alterations in Sporadic Nephrotic Syndrome Associate with Resistance to Immunosuppression
AID  - 10.1681/ASN.2013111155
DP  - 2015 Jan 01
TA  - Journal of the American Society of Nephrology
PG  - 230--236
VI  - 26
IP  - 1
4099  - http://jasn.asnjournals.org/content/26/1/230.short
4100  - http://jasn.asnjournals.org/content/26/1/230.full
SO  - J. Am. Soc. Nephrol.2015 Jan 01; 26
AB  - In children, sporadic nephrotic syndrome can be related to a genetic cause, but to what extent genetic alterations associate with resistance to immunosuppression is unknown. In this study, we designed a custom array for next-generation sequencing analysis of 19 target genes, reported as possible causes of nephrotic syndrome, in a cohort of 31 children affected by sporadic steroid-resistant nephrotic syndrome and 38 patients who exhibited a similar but steroid-sensitive clinical phenotype. Patients who exhibited extrarenal symptoms, had a familial history of the disease or consanguinity, or had a congenital onset were excluded. We identified a genetic cause in 32.3% of the children with steroid-resistant disease but zero of 38 children with steroid-sensitive disease. Genetic alterations also associated with lack of response to immunosuppressive agents in children with steroid-resistant disease (0% of patients with alterations versus 57.9% of patients without alterations responded to immunosuppressive agents), whereas clinical features, age at onset, and pathologic findings were similar in steroid‐resistant patients with and without alterations. These results suggest that heterogeneous genetic alterations in children with sporadic forms of nephrotic syndrome associate with resistance to steroids as well as immunosuppressive treatments. In these patients, a comprehensive screening using such an array may, thus, be useful for genetic counseling and may help clinical decision making in a fast and cost-efficient manner.