Renal, auricular, and ocular outcomes of Alport syndrome and their current management

Pediatr Nephrol. 2018 Aug;33(8):1309-1316. doi: 10.1007/s00467-017-3784-3. Epub 2017 Sep 1.

Abstract

Alport syndrome is a hereditary glomerular basement membrane disease caused by mutations in the COL4A3/4/5 genes encoding the type IV collagen alpha 3-5 chains. Most cases of Alport syndrome are inherited as X-linked dominant, and some as autosomal recessive or autosomal dominant. The primary manifestations are hematuria, proteinuria, and progressive renal failure, whereas some patients present with sensorineural hearing loss and ocular abnormalities. Renin-angiotensin-aldosterone system blockade is proven to delay the onset of renal failure by reducing proteinuria. Renal transplantation is a curative treatment for patients who have progressed to end-stage renal disease. However, only supportive measures can be used to improve hearing loss and visual loss. Although both stem cell therapy and gene therapy aim to repair the basement membrane defects, technical difficulties require more research in Alport mice before clinical studies. Here, we review the renal, auricular, and ocular manifestations and outcomes of Alport syndrome and their current management.

Keywords: ACE inhibitors; Alport syndrome; Hearing loss; Lenticonus; Proteinuria.

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Collagen Type IV / genetics*
  • Corneal Dystrophies, Hereditary / genetics
  • Corneal Dystrophies, Hereditary / therapy*
  • Corneal Transplantation
  • Disease Progression
  • Glomerular Basement Membrane / pathology
  • Hearing Aids
  • Hearing Loss, Sensorineural / genetics
  • Hearing Loss, Sensorineural / therapy*
  • Hematuria / genetics
  • Hematuria / therapy
  • Hematuria / urine
  • Humans
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation
  • Lens Implantation, Intraocular
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Mutation
  • Nephritis, Hereditary / genetics
  • Nephritis, Hereditary / pathology
  • Nephritis, Hereditary / therapy*
  • Nephritis, Hereditary / urine
  • Proteinuria / genetics
  • Proteinuria / therapy
  • Proteinuria / urine
  • Renin-Angiotensin System / drug effects
  • Retinal Diseases / genetics
  • Retinal Diseases / therapy*
  • Treatment Outcome

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Collagen Type IV
  • Mineralocorticoid Receptor Antagonists