Bartter and Gitelman syndromes: Questions of class.

Bartter and Gitelman syndromes: Questions of class.
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DOI:
10.1007/s00467-019-04371-y
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发表时间:
2020-10
期刊:
Pediatric nephrology (Berlin, Germany)
影响因子:
--
通讯作者:
Bockenhauer D
Bockenhauer D
中科院分区:
其他
文献类型:
--
作者:
Besouw MTP;Kleta R;Bockenhauer D

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巴特综合征和吉特曼综合征是一种罕见的遗传性肾小管病变,以低血钾、低氯血症性代谢性碱中毒为特征。它们是由至少7个基因突变引起的,这些基因参与了Henle环的粗大升支(TAL)和/或远端曲管(DCT)对钠的重吸收。根据临床症状和/或潜在的遗传原因,可以区分不同的亚型,并提出各种分类。然而,临床表型可以表现出显著的变异性,导致不同分类之间的潜在差异。这些问题主要与碱侧氯出流通道CLCNKB的作用有关,该通道在TAL和DCT中都有表达,以及密切相关的准分子CLCNKA能在多大程度上补偿CLCNKB功能的丧失。在这里,我们回顾了与这些疾病有关的运输蛋白的生理学知识。我们还回顾了各种建议的分类,并解释了为什么基于基因的分类构成了一种实用的解决方案。
Bartter and Gitelman syndromes are rare inherited tubulopathies characterized by hypokalaemic, hypochloraemic metabolic alkalosis. They are caused by mutations in at least 7 genes involved in the reabsorption of sodium in the thick ascending limb (TAL) of the loop of Henle and/or the distal convoluted tubule (DCT). Different subtypes can be distinguished and various classifications have been proposed based on clinical symptoms and/or the underlying genetic cause. Yet, the clinical phenotype can show remarkable variability, leading to potential divergences between classifications. These problems mostly relate to uncertainties over the role of the basolateral chloride exit channel CLCNKB, expressed in both TAL and DCT and to what degree the closely related paralogue CLCNKA can compensate for the loss of CLCNKB function. Here, we review what is known about the physiology of the transport proteins involved in these disorders. We also review the various proposed classifications and explain why a gene-based classification constitutes a pragmatic solution.
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