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dc.contributor.authorSavige, Judy Aen
dc.contributor.authorRana, Keshaen
dc.contributor.authorTonna, Stephenen
dc.contributor.authorBuzza, Marken
dc.contributor.authorDagher, Hayaten
dc.contributor.authorWang, Yan Yanen
dc.identifier.citationKidney International; 64(4): 1169-78en
dc.description.abstractThin basement membrane nephropathy. Thin basement membrane nephropathy (TBMN) is the most common cause of persistent glomerular bleeding in children and adults, and occurs in at least 1% of the population. Most affected individuals have, in addition to the hematuria, minimal proteinuria, normal renal function, a uniformly thinned glomerular basement membrane (GBM) and a family history of hematuria. Their clinical course is usually benign. However, some adults with TBMN have proteinuria >500 mg/day or renal impairment. This is more likely in hospital-based series of biopsied patients than in the uninvestigated, but affected, family members. The cause of renal impairment in TBMN is usually not known, but may be due to secondary focal segmental glomerulosclerosis (FSGS) or immunoglobulin A (IgA) glomerulonephritis, to misdiagnosed IgA disease or X-linked Alport syndrome, or because of coincidental disease. About 40% families with TBMN have hematuria that segregates with the COL4A3/COL4A4 locus, and many COL4A3 and COL4A4 mutations have now been described. These genes are also affected in autosomal-recessive Alport syndrome, and at least some cases of TBMN represent the carrier state for this condition. Families with TBMN in whom hematuria does not segregate with the COL4A3/COL4A4 locus can be explained by de novo mutations, incomplete penetrance of hematuria, coincidental hematuria in family members without COL4A3 or COL4A4 mutations, and by a novel gene locus for TBMN. A renal biopsy is warranted in TBMN only if there are atypical features, or if IgA disease or X-linked Alport syndrome cannot be excluded clinically. In IgA disease, there is usually no family history of hematuria. X-linked Alport syndrome is much less common than TBMN and can often be identified in family members by its typical clinical features (including retinopathy), a lamellated GBM without the collagen alpha3(IV), alpha4(IV), and alpha5(IV) chains, and by gene linkage studies or the demonstration of a COL4A5 mutation. Technical difficulties in the demonstration and interpretation of COL4A3 and COL4A4 mutations mean that mutation detection is not used routinely in the diagnosis of TBMN.en
dc.subject.otherBasement Membrane.pathologyen
dc.subject.otherChromosomes, Human, Xen
dc.subject.otherDiagnosis, Differentialen
dc.subject.otherGenetic Linkageen
dc.subject.otherGenetic Predisposition to Diseaseen
dc.subject.otherGlobal Healthen
dc.subject.otherKidney Diseases.diagnosis.epidemiology.pathology.physiopathologyen
dc.subject.otherNephritis, Hereditary.diagnosis.geneticsen
dc.subject.otherRisk Factorsen
dc.titleThin basement membrane nephropathy.en
dc.typeJournal Articleen
dc.identifier.journaltitleKidney Internationalen
dc.identifier.affiliationUniversity of Melbourne, Department of Medicine, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australiaen
dc.type.austinJournal Articleen
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
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