Mutación infrecuente en el síndrome renal-coloboma: a propósito de un caso y revisión / Infrequent mutation in renal-coloboma syndrome: case report and review

El síndrome renal-coloboma es una enfermedad autosómica dominante caracterizada por hipodisplasia renal y coloboma. Se presenta el caso de una niña de 12 años afecta de enfermedad renal crónica, colobomas papilares bilaterales y mutación excepcional del gen PAX-2. Con diagnóstico prenatal de hipoplasia renal bilateral, a los 5 días de vida, presentó clínica y datos analíticos compatibles con enfermedad renal crónica. En los controles posteriores, se apreció reflujo vesicoureteral grado ii bilateral, que se resolvió espontáneamente, proteinuria mantenida en rango no nefrótico controlada con enalapril y colobomas bilaterales con atrofia macular izquierda. La función renal se mantuvo estable. El estudio genético demostró mutación p.R104X de novo sin sentido en heterocigosis. Globalmente, existen documentados 80 casos de síndrome renal-coloboma asociado a mutaciones de este gen. Las evaluaciones oftalmológicas y genéticas son fundamentales en los casos de hipodisplasia renal. La función renal determinará el pronóstico. Se realizó una revisión bibliográfica de la etiopatogenia de la enfermedad.

Renal-coloboma syndrome is an autosomal dominant disease characterized by renal hypodysplasia and coloboma. A case of a 12-year-old girl with chronic kidney disease, bilateral optic nerve colobomas and an exceptional PAX-2 gene mutation is presented. Diagnosed in prenatal scans with bilateral renal hypoplasia, she presented clinical and laboratory findings of chronic kidney disease at 5 days of life. Following tests showed grade II bilateral vesicoureteral reflux spontaneously solved, maintained non nephrotic proteinuria controlled with enalapril and bilateral colobomas with left macular atrophy. Renal function remained stable. Genetic study showed de novo and non sense mutation p.R104X in heterocygosis. Currently there are 80 published cases of renal-coloboma syndrome associated with this gene mutations. Ophthalmologic and genetic evaluations are crucial in cases affected by renal hypodysplasia. Renal function will establish prognosis. We review the etiopathogenesis of this disease.

Bilateral iris, choroid, optic nerve colobomas and retinal detachment in an Egyptian patient with mild Baraitser-Winter syndrome

Baraitser-Winter syndrome [BRWS] is a malformation syndrome, characterized by facial dysmorphism, ocular colobomata, pachygyria, and intellectual defects. A 3.5 year old female child with BRWS has bilateral congenital ptosis, microcor-nea, iris, choroid, and optic nerve coloboma, retinal detachment, and mental retardation. She has also frontal bossing, prominent forehead, thick eyebrows, transverse slanting, hypertelorism, wide palpebral fissures, and nystagmus. The nose is broad, and bulbous with wide nares, and broad nasal tip. She has also low set posteriorly rotated ears, full cheeks, long philtrum, large mouth [macrostomia], gum hypertrophy, decayed teeth, high arched palate, pointed chin, short neck, low posterior hair line, partial left simian crease, and short fingers. MRI brain shows frontal poly-microgyria. This patient represents a mild case of Baraitser-Winter syndrome

Duplicación parcial del cromosoma 4 asociada con coloboma ocular bilateral / Partial duplication of chromosome 4 in a patient with bilateral ocular coloboma

La trisomía parcial 4q es una enfermedad cromosómica rara causada por la duplicación de una porción (comúnmente la distal) del brazo largo del cromosoma 4. En la mayoría de los casos resulta de una translocación balanceada de uno de los progenitores, siendo menos frecuente la aparición de novo. Los pacientes presentan diversas características clínicas según el tamaño y sitio específico de la región comprometida. Su asociación con patologías oculares ha sido escasamente comunicada. Presentamos el primer caso de un paciente pediátrico de sexo masculino con una duplicación parcial de novo del segmento proximal del brazo largo del cromosoma 4 (4q12-q22) y coloboma bilateral de iris, retina y nervio óptico.

Partial trisomy 4q is a rare chromosomal disease. It involves duplication of a portion (particularly the distal one) of the long arm of chromosome 4. In most cases results from a balanced translocation on one single progenitor. The "de novo" appearance is less common. Depending on the size and location of duplicated genetic material, patients may have different clinical manifestations. Associated eye pathology has been scarcely informed. We report on a novel case of a male infant with a proximal "de novo" 4q12-q22 duplication and bilateral iris, retinal and optic nerve coloboma.

Novel CHD7 and FBN1 mutations in an infant with multiple congenital anamolies.

The first case of an infant with a dual genetic diagnosis of CHARGE and Marfan syndrome is reported here. The patient had multiple congenital anamolies, many of them consistent with CHARGE syndrome and genetic testing identified a heterozygous mutation c.3806_11del6insA in the CHD7 gene. In addition, his father had physical features consistent with Marfan syndrome. Fibrillin-1 (FBN1) mutation screening identified a heterozygous c.3990insC mutation in both father and the patient.

Partial Tetrasomy of Chromosome 22q11.1 Resulting from a Supernumerary Isodicentric Marker Chromosome in a Boy with Cat-eye Syndrome

The 22q11 region has been implicated in chromosomal rearrangements that result in altered gene dosage, leading to three different congenital malformation syndromes: DiGeorge syndrome, cat-eye syndrome (CES), and der(22) syndrome. Although DiGeorge syndrome is a common genomic disorder on 22q11, CES is quite rare, and there has been no report of Korean CES cases with molecular cytogenetic confirmation. In this study, we present the phenotypic and genetic characteristics of a 3-month-old boy with CES. Clinical findings included micropthalmia, multiple colobomata, and renal and genital anomalies. Cytogenetic analyses showed the presence of a supernumerary marker chromosome, which was identified as a bisatellited and isodicentric chromosome derived from an acrocentric chromosome. The results of array comparative genomic hybridization and fluorescence in situ hybridization studies confirmed the karyotype as 47,XY,+mar.ish idic(22)(q11.1) (D22S43+).arr 22q11.1(15,500,000-15,900,000)x4, resulting in a partial tetrasomy of 22q11.1. To the best of our knowledge, this is the first report in Korea of CES confirmed by cytogenetic and molecular cytogenetic analyses.

Selected malformations of the optic nerve head - morphology etiology and associations

Although individually rare, congenital malformations of the optic nerve head can be associated with significant visual morbidity, other ocular malformations, and systemic disorders, some of which life-threatening. This paper reviews the clinical features that allow the differentiation of typical colobomas of the optic nerve head from the morning glory disk anomaly. The former can be inherited and are associated with a variety of systemic syndromes and malformations; the latter are not inherited and are associated notoriously with basal encephaloceles and with Moyamoya disease of the carotid vascular system. Finally, the papillo-renal syndrome and the PHACE syndrome are briefly reviewed and their associated optic nerve malformations delineated

Clinical characteristics of CHARGE syndrome

CHARGE syndrome, first described by Pagon, was named for its six major clinical features. They are: coloboma of the eye, heart defects, atresia of the choanae, retarded growth and development including CNS anomalies, genital hypoplasia and/or urinary tract anomalies, and ear anomalies and/or hearing loss. We experienced three cases of CHARGE syndrome who displayed ocular coloboma, heart defects, retarded growth and development, and external ear anomalies, and we also review the previously reported literature concerning CHARGE syndrome.

Associaçäo de malformaçöes oculares congênitas: coloboma, microftalmo e microcórnea: relato de 5 casos / Associated congenital ocular malformations: coloboma, microphthalmos and microcornea

Este trabalho apresenta 5 casos de pacientes com associaçäo de malformaçöes oculares composta por coloboma, microftalmo e microcórnea. Os autores tentam estabelecer o diagnóstico genético em cada caso e apresentam os procedimentos oftalmológicos realizados no sentido de minmizar o déficit visual decorrente destas alteraçöes. Discute-se também as indicaçöes e as dificuldades encontradas para a realizaçäo destes procedimentos. Houve melhora da acuidade visual em todos os casos cirúrgicos