Skip to main content
Log in

Persistent familial hematuria in children and the locus for thin basement membrane nephropathy

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

This study examined how often children with persistent familial hematuria were from families where hematuria segregated with the known genetic locus for the condition known as benign familial hematuria or thin basement membrane nephropathy (TBMN) at COL4A3/COL4A4. Twenty-one unrelated children with persistent familial hematuria as well as their families were studied for segregation of hematuria with haplotypes at the COL4A3/COL4A4 locus for benign familial hematuria and at the COL4A5 locus for X-linked Alport syndrome. Eight families (38%) had hematuria that segregated with COL4A3/COL4A4, and four (19%) had hematuria that segregated with COL4A5. At most, eight of the other nine families could be explained by disease at the COL4A3/COL4A4 locus if de novo mutations, non-penetrant hematuria or coincidental hematuria in unaffected family members was present individually or in combination. This study confirms that persistent familial hematuria is not always linked to COL4A3/COL4A4 (or COL4A5) and suggests the possibility of a further genetic locus for benign familial hematuria. This study also highlights the risk of excluding X-linked Alport syndrome on the basis of the absence of a family history or of kidney failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dodge WF, West EF, Smith EH, Bruce H (1976) Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr 88:327–347

    PubMed  Google Scholar 

  2. Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N (1979) Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 95:676–684

    PubMed  Google Scholar 

  3. Ritchie CD, Bevan EA, Collier SJ (1986) Importance of occult haematuria found at screening. BMJ 292:681–683

    PubMed  Google Scholar 

  4. Hogg RJ, Harris S, Lawrence DM, Henning PH, Wigg N, Jureidini KF (1998) Renal tract abnormalities detected in Australian preschool children. J Paediatr Child Health 34:420–424

    Article  PubMed  Google Scholar 

  5. Golin AL, Howard RS (1980) Asymptomatic microscopic hematuria. J Urol 124:389–391

    PubMed  Google Scholar 

  6. Trachtman H, Weiss RA, Bennett B, Greifer I (1984) Isolated hematuria in children: indications for a renal biopsy. Kidney Int 25:94–99

    PubMed  Google Scholar 

  7. Gauthier B, Trachtman H, Frank R, Valderrama E (1989) Familial thin basement membrane nephropathy in children with asymptomatic microhematuria. Nephron 51:502–508

    PubMed  Google Scholar 

  8. Schroder CH, Bontemps CM, Assmann KJ, Schuurmans Stekhoven JH, Foidart JM, Monnens LA, Veerkamp JH (1990) Renal biopsy and family studies in 65 children with isolated hematuria. Acta Paediatr 79:630–636

    Google Scholar 

  9. Blumenthal SS, Fritsche C, Lemann J (1988) Establishing the diagnosis of benign familial hematuria. The importance of examining the urine sediment of family members. JAMA 259:2263–2266

    Article  PubMed  Google Scholar 

  10. Kincaid-Smith P (1995) Textbook of nephrology. Thin basement membrane disease, part 13. Lippincott, Williams and Wilkins, Philadelphia, pp 760–764

  11. Auwardt R, Savige J, Wilson D (1999) A comparison of the clinical and laboratory features of thin basement membrane disease (TBMD) and IgA glomerulonephritis (IgAGN). Clin Nephrol 52:1–4

    PubMed  Google Scholar 

  12. Piel CF, Biava CG, Goodman JR (1982) Glomerular basement membrane attenuation in familial nephritis and “benign” hematuria. J Pediatr 101:358–365

    PubMed  Google Scholar 

  13. Collar JE, Ladva S, Cairns TD, Cattell V (2001) Red cell traverse through thin glomerular basement membranes. Kidney Int 59:2069–2072

    PubMed  Google Scholar 

  14. Barker DF, Hostikka SL, Zhou J, Chow LT, Oliphant AR, Gerken SC, Gregory MC, Skolnick MH, Atkin CL, Tryggvason K (1990) Identification of mutations in the COL4A5 gene in Alport syndrome. Science 248:1224–1227

    PubMed  Google Scholar 

  15. Mochizuki T, Lemmink HH, Mariyama M, Antignac C, Gubler M, Pirson Y, Verellen-Dumoulin C, Chan B, Schroder CH, Smeets HJ, Reeders ST (1994) Identification of mutations in the alpha 3(IV) and alpha 4(IV) collagen genes in autosomal recessive Alport syndrome. Nat Genet 8:77–81

    Article  PubMed  Google Scholar 

  16. Lemmink HH, Nillesen WN, Mochizuki T, Schroder CH, Brunner HG, van Oost BA, Monnens LAH, Smeets HJM (1996) Benign familial hematuria due to mutation of the type IV collagen α4 gene. J Clin Invest 98:1114–1118

    PubMed  Google Scholar 

  17. Lambrecht R, Gross O, Netzer KO (1996) Autosomal recessive Alport syndrome and benign familial hemturia: diseases of the same origin? J Am Soc Nephrol 7:1616A

    Google Scholar 

  18. Netzer KO, Seibold S, Weber M (1999) Thin basement membrane—do we have a window for understanding the molecular pathogenesis? Nephrol Dial Transplant 14:1060–1061

    Article  PubMed  Google Scholar 

  19. Boye E, Mollet G, Forestier L, Cohen-Solal L, Heidet L, Cochat P, Grunfeld J, Palcoux J, Gubler M, Antignac C (1998) Determination of the genomic structure of the COL4A4 gene and of novel mutations causing autosomal recessive Alport syndrome. Am J Hum Genet 63:1329–1340

    Article  PubMed  Google Scholar 

  20. Buzza M, Wilson D, Savige J (2001) Segregation of hematuria in thin basement membrane disease with haplotypes at the loci for Alport syndrome. Kidney Int 59:1670–1676

    Article  PubMed  Google Scholar 

  21. Buzza M, Wang YY, Dagher H, Babon JJ, Cotton RG, Powell H, Dowling J, Savige J (2001) COL4A4 mutation in thin basement membrane disease previously described in Alport syndrome. Kidney Int 60:480–483

    Article  PubMed  Google Scholar 

  22. Ozen S, Ertoy D, Heidet L, Cohen-Solal L, Ozen H, Besbas N, Bakkaoglu A, Antignac C (2001) Benign familial hematuria associated with a novel COL4A4 mutation. Pediatr Nephrol 16:874–877

    Article  PubMed  Google Scholar 

  23. Longo I, Porcedda P, Mari F, Giachino D, Meloni I, Deplano C, Brusco A, Bosio M, Massella l, Lavoratti G, Roccatello D, Frasca G, Mazzucco G, Onetti Muda A, Conti M, Fasciolo F, Arrondel C, Heidet L, Renieri A, De Marchi M (2002) COL4A3/COL4A4 mutations: from familial hematuria to autosomal dominant or recessive Alport syndrome. Kidney Int 61:1947–1956

    Article  PubMed  Google Scholar 

  24. Badenas C, Praga M, Tazon B, Heidet L, Arrondel C, Armengol A, Andres A, Morales E, Camacho JA, Lens X, Davila S, Mila M, Antignac C, Darnell A, Torra R (2002) Mutations in the COL4A3 and COL4A4 genes cause familial benign hematuria. J Am Soc Nephrol 13:1248–1254

    PubMed  Google Scholar 

  25. Buzza M, Dagher H, Wang YY, Wilson D, Babon JJ, Cotton RG, Savige J (2003) Mutations in the COL4A4 gene in thin basement membrane disease (TBMD). Kidney Int 63:447–453

    Article  PubMed  Google Scholar 

  26. Yamazaki H, Nakagawa Y, Saito A, et al (1995) No linkage to the COL4A3 gene locus in Japanese thin basement membrane disease families. Nephrology 1:315–321

    Google Scholar 

  27. Piccini M, Casari G, Zhou J, et al (1999) Evidence for genetic heterogeneity in benign familial hematuria. Am J Nephrol 19:464–467

    Article  PubMed  Google Scholar 

  28. Rumpelt HJ, Langer KH, Scharer K, Straub E, Thoenes W (1974) Split and extremely thin glomerular basement membranes in hereditary nephropathy (Alport’s syndrome). Virchows Arch 364:225–233

    Article  Google Scholar 

  29. Fairley KF, Birch DF (1982) Hematuria: a simple method for identifying glomerular bleeding. Kidney Int 21:105–108

    PubMed  Google Scholar 

  30. Jefferson JA, Lemmink HH, Hughes AE, Hill CM, Smeets HJ, Doherty CC, Maxwell AP (1997) Autosomal dominant Alport syndrome linked to the type IV collagen α3 and α4 genes (COL4A3 and COL4A4). Nephrol Dial Transplant 12:1595–1599

    Article  PubMed  Google Scholar 

  31. Gyapay G, Morissette J, Vignal A, Dib C, Fizames C, Millasseau P, Marc S, Bernardi G, Lathrop M, Weissenbach J (1994) The 1993–1994 Genethon human genetic linkage map. Nat Genet 7:246–339

    Article  PubMed  Google Scholar 

  32. Barker DF, Cleverly J, Fain PR (1992): Two CA-dinucleotide polymorphisms at the COL4A5 (Alport syndrome) gene in Xq22. Nucleic Acids Res 20:929

    Google Scholar 

  33. Luty JA, Guo Z, Willard HF, Ledbetter DH, Ledbetter S, Litt M (1990) Five polymorphic microsatellite VNTRs on the human X chromosome. Am J Human Genet 46:776–783

    Google Scholar 

  34. Lajoie G (2001) Approach to the diagnosis of thin basement membrane nephropathy in females with the use of antibodies to type IV collagen. Arch Pathol Lab Med 125:631–636

    PubMed  Google Scholar 

  35. van der Loop FT, Monnens LA, Schroder CH, Lemmink HH, Breuning MH, Timmer ED, Smeets HJ (1999) Identification of COL4A5 defects in Alport’s syndrome by immunohistochemistry of skin. Kidney Int 55:1217–1224

    Article  PubMed  Google Scholar 

  36. Lemmink HH, Schroder CH, Monnens LA, Smeets HJ (1997) the clinical spectrum of type IV collagen mutations. Human Mutat 9:477–499

    Article  Google Scholar 

  37. Dagher H, Buzza M, Colville D, Jones C, Powell H, Fassett R, Wilson D, Agar J, Savige J (2001) A comparison of the clinical, histopathological and ultrastructural phenotypes in carriers of X-linked and autosomal recessive Alport syndrome. Am J Kidney Dis 38:1217–1228

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Judy Savige.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rana, K., Wang, Y.Y., Powell, H. et al. Persistent familial hematuria in children and the locus for thin basement membrane nephropathy. Pediatr Nephrol 20, 1729–1737 (2005). https://doi.org/10.1007/s00467-005-2034-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-005-2034-2

Keywords

Navigation