False-positive newborn screening mimicking glutaric aciduria type I in infants with renal insufficiency

J Inherit Metab Dis. 2009 Dec:32 Suppl 1:S355-9. doi: 10.1007/s10545-009-9017-6. Epub 2009 Dec 23.

Abstract

Glutaric aciduria type I (GA I), an autosomal-recessive deficiency of glutaryl-CoA-dehydrogenase, leads to encephalopathic crises resulting in irreversible neurological damage. As early diagnosis and implementation of appropriate treatment has significant benefit for these patients, GA I has been implemented in the extended newborn screening program in several countries. Screening parameter is glutarylcarnitine (C5DC) with its ratios. From 1 January 2005 until 31 December 2008, 173,846 newborns were examined by neonatal screening in our screening center. C5DC and/or at least three C5DC/acylcarnitine ratios were increased in 53 newborns (0.03%) and persisted in 11 infants after recall. GA I was not confirmed in any of these infants, but all 11 infants were suffering from renal insufficiency due to congenital (5/11) or acquired (6/11) renal disease. C5DC was shown to be significantly associated with renal affection and was significantly higher in infants with congenital renal insufficiency than in those with acquired renal insufficiency (p = 0.011). Creatinine correlated significantly with C5DC (p = 0.001) and all C5DC/acylcarnitine ratios, mainly with C5DC/(C8 + C10), C5DC/C0, C5DC/C2, C5DC/C4, and C5DC/C8 (for all: p = 0.001). Glutarylcarnitinemia associated with renal insufficiency has not yet been studied systematically. Renal damage in neonates might lead to disturbances in renal transporter systems of glutaric acid and its metabolites and a decreased excretion of C5DC, thus resulting in an increase of plasma C5DC. Therefore, newborns presenting with a positive screening indicating GA I may be considered not only to suffer from GA I but from renal insufficiency as well.

MeSH terms

  • Amino Acid Metabolism, Inborn Errors / blood
  • Amino Acid Metabolism, Inborn Errors / diagnosis*
  • Brain Diseases, Metabolic / blood
  • Brain Diseases, Metabolic / diagnosis*
  • Carnitine / analogs & derivatives
  • Carnitine / blood
  • Diagnosis, Differential
  • False Positive Reactions
  • Female
  • Germany
  • Glutaryl-CoA Dehydrogenase / blood
  • Glutaryl-CoA Dehydrogenase / deficiency
  • Humans
  • Infant, Newborn
  • Male
  • Neonatal Screening*
  • Renal Insufficiency / blood
  • Renal Insufficiency / congenital
  • Renal Insufficiency / diagnosis*

Substances

  • glutarylcarnitine
  • Glutaryl-CoA Dehydrogenase
  • Carnitine

Supplementary concepts

  • Glutaric Acidemia I