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Intrafamilial Disease Heterogeneity in Primary Hyperoxaluria Type 1
Lisa J Deesker1, Hazal A Karacoban1, Elisabeth L Metry1
1Department of Pediatric Nephrology, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.
Primary hyperoxaluria type 1 (PH1) shows significant intrafamilial variation. Siblings of PH1 patients often have better kidney survival and clinical outcomes than index cases, highlighting the importance of early family screening.
Area of Science:
- Nephrology
- Genetics
- Rare Diseases
Background:
- Primary hyperoxaluria type 1 (PH1) exhibits considerable clinical variability, even among family members.
- The full extent of this intrafamilial clinical heterogeneity remains understudied.
Purpose of the Study:
- To investigate intrafamilial clinical heterogeneity and disease progression in siblings with PH1.
- To analyze differences in kidney survival between index cases and their affected siblings.
Main Methods:
- Retrospective registry study using OxalEurope data from PH1 families with multiple affected siblings.
- Development and application of a 6-point scoring system to assess intrafamilial clinical heterogeneity.
- Kaplan-Meier analysis to compare kidney survival rates.
Main Results:
- 38% of 88 included PH1 families displayed significant intrafamilial clinical heterogeneity.
- Affected siblings, particularly those diagnosed asymptomatically, showed significantly better clinical outcomes and kidney survival than index cases (P < 0.001).
- Index cases experienced kidney failure earlier in life and follow-up compared to siblings (P < 0.001).
Conclusions:
- Intrafamilial clinical heterogeneity is common in familial PH1.
- Early diagnosis through family screening can improve prognosis for siblings with PH1 due to better outcomes and kidney survival.
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