2021, Número 1
<< Anterior Siguiente >>
Rev Nefrol Dial Traspl 2021; 41 (1)
Síndrome de Alport: Una actualización en Fisiopatología, Genética, diagnóstico y tratamiento
Courville K, Núñez-Samudio V, Landires I
Idioma: Español
Referencias bibliográficas: 52
Paginas: 62-71
Archivo PDF: 384.58 Kb.
RESUMEN
El síndrome de Alport es una
enfermedad renal hereditaria de curso
progresivo, que ocurre por defectos
genéticos en los genes responsables
de la constitución de la membrana
basal glomerular. Las mutaciones
patogénicas en los genes para el
colágeno tipo IV (COL 4A3/4/5)
producen una alteración en el arreglo
correcto de la membrana basal a
nivel glomerular. La presentación
clínica puede variar dependiendo de
la mutación que presente el paciente.
Luego de confirmar el diagnóstico,
con estudios genéticos o mediante
biopsia, se hace necesaria la correlación
genotipo-fenotipo para determinar
pronóstico y tratamiento. La reducción
de la proteinuria, según sugieren las
guías de manejo, ha resultado en un
retraso en la progresión a enfermedad
renal crónica, mientras se concluyen
los estudios con medicamentos
innovadores dirigidos a receptores
específicos.
REFERENCIAS (EN ESTE ARTÍCULO)
Hudson BG. The molecular basis of Goodpasture andAlport syndromes: beacons for the discovery of thecollagen IV family. J Am Soc Nephrol. 2004;15(10):2514-27. doi:10.1097/01.ASN.0000141462.00630.76
Tapia-Cerpa CE, Miyahira-Arakaki J. Síndrome deAlport autosómico recesivo. A propósito de un caso.Rev Med Hered. 2008;19(1):25-8.
Kruegel J, Rubel D, Gross O. Alport syndrome--insightsfrom basic and clinical research. Nat Rev Nephrol.2013;9(3):170-8. doi: 10.1038/nrneph.2012.259.
Heidet L, Gubler MC. Syndrome d’Alport :néphropathie héréditaire associée à des mutationsdans les gènes codant les chaînes de collagène detype IV [Alport syndrome: Hereditary nephropathyassociated with mutations in genes coding for type IVcollagen chains]. Nephrol Ther. 2016;12(7):544-51. doi:10.1016/j.nephro.2016.09.001.
Rubel D, Frese J, Martin M, Leibnitz A, GirgertR, Miosge N, et al. Collagen receptors integrinalpha2beta1 and discoidin domain receptor 1 regulatematuration of the glomerular basement membrane andloss of integrin alpha2beta1 delays kidney fibrosis inCOL4A3 knockout mice. Matrix Biol. 2014; 34:13-21.doi: 10.1016/j.matbio.2014.01.006.
Cosgrove D, Liu S. Collagen IV diseases: A focus on theglomerular basement membrane in Alport syndrome.Matrix Biol. 2017;57-58:45-54. doi: 10.1016/j.matbio.2016.08.005.
Hudson BG, Tryggvason K, Sundaramoorthy M,Neilson EG. Alport’s syndrome, Goodpasture’ssyndrome, and type IV collagen. N Engl J Med.2003;348(25):2543-56. doi: 10.1056/NEJMra022296
Williams EW, Turner AN. Glomerular basementmembrane disorders and the kidney.Medicine. 2015;43(9):526-8. doi: 10.1016/j.mpmed.2015.06.010.
Plevová P, Gut J, Janda J. Familial hematuria: areview. Medicina (Kaunas). 2017;53(1):1-10. doi: 10.1016/j.medici.2017.01.002.
Longo I, Porcedda P, Mari F, Giachino D, Meloni I,Deplano C, et al. COL4A3/COL4A4 mutations: fromfamilial hematuria to autosomal-dominant or recessiveAlport syndrome. Kidney Int. 2002;61(6):1947-56. doi:10.1046/j.1523-1755.2002.00379.x
Gross O, Netzer KO, Lambrecht R, Seibold S, WeberM. Novel COL4A4 splice defect and in-frame deletionin a large consanguine family as a genetic link betweenbenign familial haematuria and autosomal Alportsyndrome. Nephrol Dial Transplant.2003;18(6):1122-7. doi: 10.1093/ndt/gfg157.
Kashtan CE. Familial hematuria due to type IVcollagen mutations: Alport syndrome and thinbasement membrane nephropathy. Curr OpinPediatr. 2004;16(2):177-81. doi: 10.1097/00008480-200404000-00011.
Deltas C, Pierides A, Voskarides K. Molecular geneticsof familial hematuric diseases. Nephrol Dial Transplant.2013;28(12):2946-60. doi: 10.1093/ndt/gft253.
Savige J, Storey H, Il Cheong H, Kang HG, ParkE, Hilbert P, et al. X-linked and autosomal recessiveAlport syndrome: pathogenic variant features andfurther genotype-phenotype correlations. PLoSOne. 2016;11(9):e0161802. doi: 10.1371/journal.pone.0161802.
Wang Y, Sivakumar V, Mohammad M, ColvilleD, Storey H, Flinter, et al. Clinical and geneticfeatures in autosomal recessive and X-linked Alportsyndrome. Pediatr Nephrol. 2014;29(3):391-6. doi:10.1007/s00467-013-2643-0.
Jais JP, Knebelmann B, Giatras I, De Marchi M,Rizzoni G, Renieri A, et al. X-linked Alport syndrome:natural history and genotype-phenotype correlationsin girls and women belonging to 195 families: a“European Community Alport Syndrome ConcertedAction” study. J Am Soc Nephrol. 2003;14(10):2603-10.doi: 10.1097/01.asn.0000090034.71205.74.
Xu JM, Zhang SS, Zhang Q, Zhou YM, Zhu CH, GeJ, et al. Ocular manifestations of Alport syndrome. IntJ Ophthalmol. 2010;3(2):149-51. doi: 10.3980/j.issn.2222-3959.2010.02.13.
McCarthy PA, Maino DM. Alport syndrome: a review.Clin Eye Vis Care. 2000;12(3-4):139-50. doi: 10.1016/S0953-4431(00)00042-4.
Savige J, Ariani F, Mari F, Bruttini M, Renieri A,Gross O, et al. Expert consensus guidelines for thegenetic diagnosis of Alport syndrome. Pediatr Nephrol. 2019;34(7):1175-89. doi: 10.1007/s00467-018-3985-4.
Kashtan CE. Alport Syndrome. En: Adam MP,Ardinger HH, Pagon RA, et al. GeneReviews®[Internet]. Seattle: University of Washington, 1993-2020. Disponible en: (consulta: 11/07/2019).
Praga M, Caravaca F, Yuste C, Cavero T, HernándezE, Morales E, et al. Nefropatía IgA: ¿qué pacientes estánen riesgo de progresar a enfermedad renal terminaly cómo deberían ser tratados? Nefrología (Madr.).2018;38(4):347-52. doi: 10.1016/j.nefro.2018.01.001.
Alport Syndrome Rare Disease Group. AlportSyndrome: clinician information [Internet]. En:RareRenal Information on Rare Kidney Disease.Disponible en: (consulta: 01/01/2020).
Savige J, Gregory M, Gross O, Kashtan C, Ding J,Flinter F. Expert guidelines for the managementof Alport syndrome and thin basement membranenephropathy. J Am Soc Nephrol. 2013;24(3):364-75.doi: 10.1681/ASN.2012020148.
Heidet L, Gubler MC. The renal lesions of Alportsyndrome. J Am Soc Nephrol. 2009;20(6):1210-5. doi:10.1681/ASN.2008090984.
Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKDAtlas of Renal Pathology: Alport Syndrome. AmJ Kidney Dis. 2016;68(4):e15-e16. doi: 10.1053/j.ajkd.2016.08.002.
van der Loop FT, Monnens LA, Schröder CH,Lemmink HH, Breuning MH, Timmer ED, etal. Identification of COL4A5 defects in Alport’ssyndrome by immunohistochemistry of skin. KidneyInt. 1999;55(4):1217-24. doi: 10.1046/j.1523-1755.1999.00357.x.
Praga M, Torra R, Tazón B. Hematuria familiarbenigna. Nefrología (Madr.). 2003;23(Suppl. 1):40-5.
Singh N, Nainani N, Arora P, Venuto RC. CKDin MYH9-related disorders. Am J Kidney Dis.2009;54(4):732-40. doi: 10.1053/j.ajkd.2009.06.023.
Simckes A, Blowey D, Gyves K, Alon US. Successand safety of same-day kidney biopsy in children andadolescents. Pediatr Nephrol. 2000;14(10-11):946-52.doi: 10.1007/s004670000316.
Miglinas M. Utility of renal biopsy in the clinicalmanagement of renal disease: hematuria should notbe missed. Kidney Int. 2014;86(6):1269. doi: 10.1038/ki.2014.277.
Liderman S. Registro Argentino de Biopsias Renales.Reporte de situación en Capital Federal y GranBuenos Aires a abril del 2008. Rev Nefrol Dial Traspl.2008;28(2):55-60.
Orta N, Sanna V, Moriyón JC, de Orta S, DomínguezL, Zibaoui P, et al. Hematuria en niños: análisis de lacasuística en un centro de referencia nacional. Valencia,Venezuela. Rev Chil Pediatr. 2001;72(2):92-9. doi:10.4067/S0370-41062001000200003.
Kashtan CE, Ding J, Gregory M, Gross O, Heidet L,Knebelmann B, et al. Clinical practice recommendationsfor the treatment of Alport syndrome: a statement ofthe Alport Syndrome Research Collaborative. PediatrNephrol. 2013;28(1):5-11. doi: 10.1007/s00467-012-2138-4.
Cravedi P, Remuzzi G. Pathophysiology of proteinuriaand its value as an outcome measure in chronic kidneydisease. Br J Clin Pharmacol. 2013;76(4):516-23. doi:10.1111/bcp.12104.
Gross O, Beirowski B, Koepke ML, Kuck J, ReinerM, Addicks K, et al. Preemptive ramipril therapy delaysrenal failure and reduces renal fibrosis in COL4A3-knockout mice with Alport syndrome. KidneyInt. 2003;63(2):438-46. doi: 10.1046/j.1523-1755.2003.00779.x.
de Lucas Collantes C, Izquierdo García E.Proteinuria. En: Protocolos diganósticos y terapéuticosen nefrología pediátrica [Internet]. 3a ed. Madrid:Asociación Española de Pediatría, 2014, pp. 69-79.(Serie Protocolos de la AEP). Disponible en: (consulta: 01/01/2020).
Proesmans W, Van Dyck M. Enalapril in children withAlport syndrome. Pediatr Nephrol. 2004;19(3):271-5.doi: 10.1007/s00467-003-1366-z.
European Alport Therapy Registry. European initiativetowards delaying renal failure in Alport syndrome[Internet]. ClinicalTrials.gov: NCT02378805. Firstposted: March 4, 2015; Last update: March 24, 2020.Disponible en: (consulta: 01/01/2020).
Wühl E, Mehls O, Schaefer F; ESCAPE Trial Group.Antihypertensive and antiproteinuric efficacy oframipril in children with chronic renal failure. KidneyInt. 2004;66(2):768-76. doi: 10.1111/j.1523-1755.2004.00802.x.
Seeman T, Pohl M, Misselwitz J, John U. Angiotensinreceptor blocker reduces proteinuria independentlyof blood pressure in children already treated withAngiotensin-converting enzyme inhibitors. Kidney BloodPress Res. 2009;32(6):440-4. doi: 10.1159/000266478.
Lubrano R, Soscia F, Elli M, Ventriglia F, Raggi C,Travasso E, et al. Renal and cardiovascular effectsof angiotensin-converting enzyme inhibitor plusangiotensin II receptor antagonist therapy in childrenwith proteinuria. Pediatrics. 2006;118(3):e833-8. doi:10.1542/peds.2005-2053.
Savva I, Pierides A, Deltas C. RAAS inhibitionand the course of Alport syndrome. Pharmacol Res.2016;107:205-10. doi: 10.1016/j.phrs.2016.03.017.
Kaito H, Nozu K, Iijima K, Nakanishi K, YoshiyaK, Kanda K, et al. The effect of aldosterone blockadein patients with Alport syndrome. Pediatr Nephrol.2006;21(12):1824-9. doi: 10.1007/s00467-006-0270-8.
Ku E, Campese VM. Role of aldosterone in theprogression of chronic kidney disease and potential useof aldosterone blockade in children. Pediatr Nephrol.2009;24(12):2301-7. doi: 10.1007/s00467-009-1176-z.
Zhang Z, Li Z, Cao K, Fang D, Wang F, Bi G, etal. Adjunctive therapy with statins reduces residualalbuminuria/proteinuria and provides furtherrenoprotection by downregulating the angiotensinII-AT1 pathway in hypertensive nephropathy. JHypertens. 2017;35(7):1442-56. doi: 10.1097/HJH.0000000000001325.
Daina E, Cravedi P, Alpa M, Roccatello D, Gamba S,Perna A, et al. A multidrug, antiproteinuric approachto Alport syndrome: a ten-year cohort study. Nephron.2015;130(1):13-20. doi: 10.1159/000381480.
LeBleu V, Sugimoto H, Mundel TM, Gerami-NainiB, Finan E, Miller CA, et al. Stem cell therapies benefitAlport syndrome. J Am Soc Nephrol. 2009;20(11):2359-70. doi: 10.1681/ASN.2009010123.
Moschidou D, Corcelli M, Hau KL, Ekwalla VJ,Behmoaras JV, De Coppi P, et al. Human chorionicstem cells: podocyte differentiation and potential forthe treatment of Alport syndrome. Stem Cells Dev.2016;25(5):395-404. doi: 10.1089/scd.2015.0305.
Massella L, Muda AO, Legato A, Di Zazzo G,Giannakakis K, Emma F. Cyclosporine a treatmentin patients with Alport syndrome: a single-centerexperience. Pediatr Nephrol. 2010;25(7):1269-75. doi:10.1007/s00467-010-1484-3.
Gross O, Perin L, Deltas C. Alport syndrome frombench to bedside: the potential of current treatmentbeyond RAAS blockade and the horizon of futuretherapies. Nephrol Dial Transplant. 2014;29(Suppl.4):iv124-30. doi: 10.1093/ndt/gfu028.
Kashtan CE, McEnery PT, Tejani A, StableinDM. Renal allograft survival according to primarydiagnosis: a report of the North American PediatricRenal Transplant Cooperative Study. Pediatr Nephrol.1995;9(6):679-84. doi: 10.1007/bf00868709.
Suranyi E, Nagy V, Berta A, Matyus J, Szalai E,Ujhelyi B, et al. Alport patients without classic ocularsymptoms have smaller lens diameter. Med Sci Monit.2019;25:2274-7. doi: 10.12659/MSM.912924.