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{{CMG}}
{{CMG}} {{AE}} [[nabeel ahmed]]
==Overview==
==Overview==
 
Medullary cystic kidney disease (MCKD) is an [[autosomal dominant]] kidney disorder characterized by [[tubulointerstitial sclerosis]] leading to end-stage renal disease [[autosomal dominant]] interstitial kidney disease (ADIKD) is a rare and [[heterogeneous]] genetic disorder. Medullary cystic kidney disease (MCKD) − MCKD is another term that has been used for ADIKD.  
==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
==Classification==
==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
Medullary cystic kidney disease  may be classified according to genetic mutation  into:
:*[group1]
*[[Mutations]] in the UMOD gene, which encodes [[uromodulin]] are present in the majority of cases of ADIKD . This condition has also  called uromodulin-associated kidney disease (UAKD) , medullary cystic kidney disease type 2 (MCKD2) and [[familial juvenile]] [[hyperuricemic nephropathy]] (FJHN) .
:*[group2]
*Mutations in the REN gene, which encodes renin.
:*[group3]
*[[Mutations]] in the MUC1 gene, which encodes mucin 1 ,called  as medullary cystic kidney disease type 1 (MCKD1).<ref name="pmid14569098">{{cite journal |vauthors=Dahan K, Devuyst O, Smaers M, Vertommen D, Loute G, Poux JM, Viron B, Jacquot C, Gagnadoux MF, Chauveau D, Büchler M, Cochat P, Cosyns JP, Mougenot B, Rider MH, Antignac C, Verellen-Dumoulin C, Pirson Y |title=A cluster of mutations in the UMOD gene causes familial juvenile hyperuricemic nephropathy with abnormal expression of uromodulin |journal=J. Am. Soc. Nephrol. |volume=14 |issue=11 |pages=2883–93 |date=November 2003 |pmid=14569098 |doi= |url=}}</ref>
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*'''Uromodulin associated kidney disease ( UAKD )''' :
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
** UAKD is due to mutations in the UMOD gene on chromosome 16p12, which encodes uromodulin (Tamm-Horsfall mucoprotein).
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
** [[Missense mutations|Missense mutation]] in exon 4 or 5 , it very rare  mutation in exons 6 or 8.
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
** Uromodulin is produced exclusively in the thick ascending limb of the [[loop of Henle]]. It is an insoluble protein whose sticky, adherent properties are probably important in maintaining the watertight integrity of the [[Thick ascending limb of loop of Henle|thick ascending limb]].
 
** Uromodulin also appears to facilitate intracellular transport of both the Na-K-2Cl [[Furosemide detailed information|furosemide]]-sensitive transporter and the [[ROMK|ROMK potassium channel]] on the apical surface of the thick ascending loop tubular cells.
==Clinical Features==
** [[Intracellular accumulation]] of abnormal uromodulin proteins can lead to tubular cell atrophy and death.
 
** The abnormal uromodulin appears to impair the synthesis and secretion of normal uromodulin produced from the unaffected allele, resulting in a marked reduction in urinary uromodulin excretion. <ref name="pmid12900848">{{cite journal |vauthors=Bleyer AJ, Trachtman H, Sandhu J, Gorry MC, Hart TC |title=Renal manifestations of a mutation in the uromodulin (Tamm Horsfall protein) gene |journal=Am. J. Kidney Dis. |volume=42 |issue=2 |pages=E20–6 |date=August 2003 |pmid=12900848 |doi= |url=}}</ref>
==Differentiating [disease name] from other Diseases==
There is two major pathophysiologic effects of uromodulin gene mutations: [[Hyperuricemia]] and progressive [[chronic kidney disease]].
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
*'''Hyperuricemia''' :
:*[Differential dx1]
** Due to accumulation of abnormal uromodulin in [[thick ascending limb]] cells leads sequentially to impaired NaCl reabsorption, mild renal salt wasting, volume contraction, and a secondary increase in proximal [[urate]] reabsorption, which restores volume status to normal but leads to [[hyperuricemia]].
:*[Differential dx2]
** '''Progressive chronic kidney disease'''  :
:*[Differential dx3]
** Due to tubular cell death in the [[Thick ascending limb of loop of Henle|thick ascending limb]] due to accumulation of mutant uromodulin. Renal biopsy reveals [[Tubulointerstitial diseases of the kidney|tubulointerstitial disease]] but no [[Uric acid nephrolithiasis|uric acid crystals]]. <ref name="pmid19465746">{{cite journal |vauthors=Williams SE, Reed AA, Galvanovskis J, Antignac C, Goodship T, Karet FE, Kotanko P, Lhotta K, Morinière V, Williams P, Wong W, Rorsman P, Thakker RV |title=Uromodulin mutations causing familial juvenile hyperuricaemic nephropathy lead to protein maturation defects and retention in the endoplasmic reticulum |journal=Hum. Mol. Genet. |volume=18 |issue=16 |pages=2963–74 |date=August 2009 |pmid=19465746 |pmc=2714724 |doi=10.1093/hmg/ddp235 |url=}}</ref>
   
*'''Mutations in the REN gene :'''
==Epidemiology and Demographics==
**The [[renin]] gene is located on chromosome 1. Two REN gene mutations associated with autosomal dominant interstitial kidney disease (ADIKD) which is due to signal sequence of pre-prorenin.
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
** [[Mutations]] in this signal sequence disrupt the [[translocation]] of pre-prorenin into the [[endoplasmic reticulum]] of [[renin]] expressing cells.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
** [[Renin]] is necessary  for [[nephrogenesis]], [[homozygous deletions]] of renin result in death during uterine development.
** [[Renin]] is present in multiple segments of the renal tubule, also on the [[Juxtaglomerular apparatus|juxtaglomerular complex]]. In these cells, pre-prorenin is translocated into the [[endoplasmic reticulum]], where it is converted to prorenin.
** Prorenin is secreted, while the remainder is targeted to [[lysosomes]] where it is further cleaved to active [[renin]].
** [[Mutations]] which disrupt the signal sequence of prorenin prevent proper [[translocation]] to the [[endoplasmic reticulum]],as a result accumulation of pre-prorenin in the cytoplasm of [[renin]] producing cells.
** Due to accumulation of pre-prorenin in renal tubular cells leads to ultrastructural damage and [[apoptosis]] .<ref name="pmid19664745">{{cite journal |vauthors=Zivná M, Hůlková H, Matignon M, Hodanová K, Vylet'al P, Kalbácová M, Baresová V, Sikora J, Blazková H, Zivný J, Ivánek R, Stránecký V, Sovová J, Claes K, Lerut E, Fryns JP, Hart PS, Hart TC, Adams JN, Pawtowski A, Clemessy M, Gasc JM, Gübler MC, Antignac C, Elleder M, Kapp K, Grimbert P, Bleyer AJ, Kmoch S |title=Dominant renin gene mutations associated with early-onset hyperuricemia, anemia, and chronic kidney failure |journal=Am. J. Hum. Genet. |volume=85 |issue=2 |pages=204–13 |date=August 2009 |pmid=19664745 |pmc=2725269 |doi=10.1016/j.ajhg.2009.07.010 |url=}}</ref>
==Epidemiology==
===Age===
===Age===
*Patients of all age groups may develop [disease name].
*Patients of all age groups may develop medullary cystic kidney disease.
*Medullary cystic kidney disease is more commonly observed among teenage years but end stage renal disease usually occurring between the ages of 20 and 70 years old.
*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
   
   
===Gender===
===Gender===
*[Disease name] affects men and women equally.
*Medullary cystic kidney disease affects men and women equally.
*Male are more commonly affected with medullary cystic kidney disease than female.<ref name="pmid25165175">{{cite journal |vauthors=Simms RJ, Ong AC |title=How simple are 'simple renal cysts'? |journal=Nephrol. Dial. Transplant. |volume=29 Suppl 4 |issue= |pages=iv106–12 |date=September 2014 |pmid=25165175 |pmc=4158337 |doi=10.1093/ndt/gfu106 |url=}}</ref>
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===
*There is no racial predilection for [disease name].
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].
   
   
==Risk Factors==
==Risk Factors==
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Medullary cystic kidney disease (MCKD) is an [[autosomal dominant]] kidney disorder.
* Characterized by tubulointerstitial sclerosis leading to [[end-stage renal disease]]. [[Autosomal dominant]] interstitial kidney disease (ADIKD) is a rare and heterogeneous genetic disorder.
== Natural History, Complications and Prognosis==
 
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
== Differential diagnosis ==
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
For a list of diseases that should be differentiated from medullary cystic kidney disease, click [[Polycystic kidney disease differentiating polycystic kidney disease from other diseases|'''''here''''']].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
 
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
== Complications and Prognosis ==
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].
Medullary cystic kidney disease may lead to following health problems:<ref name="pmid16229212">{{cite journal |vauthors=Stanisić M, Hrvacević R, Paunić Z, Petrović S |title=[Nephronophthisis and medullary cystic kidney disease complex] |journal=Vojnosanit Pregl |volume=62 |issue=9 |pages=683–8 |date=September 2005 |pmid=16229212 |doi= |url=}}</ref>
* [[Anemia]]
* [[Cardiac tamponade]]
* Bone weakness and fractures
* Change in glucose metabolism
* [[End stage renal disease]]
* [[Congestive heart failure]]  
* [[Hyponatremia]]
* [[Gastrointestinal bleeding]] and ulcers
* [[Hemorrhage]]
* Hyperkalemia
* [[Pericarditis]]
* [[Peripheral neuropathy]]
* Platelet dysfunction with easy bruising
* Menstrual problems
* [[Miscarriage]]
* [[Infertility]]
==Symptoms==
Symptoms usually begin before the age of 20, but they vary great.
* Excessive urination, caused by the reduced ability of the diseased kidneys to respond to antidiuretic (fluid-holding) hormone
 
* [[Anorexia]]
* [[Pruritus]]
* [[Enuresis]]
* [[Osteomalacia]]  
* [[Pallor]]
* [[Polydipsia]]
* Patients with REN gene mutations develop early onset [[gout]]
* Anemia, with low [[erythropoietin]] levels
* Mild [[hyperkalemia]]  
* Affected patients may be at increased risk for [[acute kidney injury]] in the setting of volume depletion and/or when [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] are used.


== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
* The diagnosis medullary cystic kidney disease suspected based upon clinical manifestations and the family history, and can be confirmed through genetic testing.
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
* A presumptive clinical diagnosis of medullary cystic kidney disease in a young individual presenting with [[gout]] and [[Chronic renal failure|chronic kidney disease]] relies upon three factors:
:*[criterion 1]
** A strong family history of kidney disease in a pattern suggestive of [[autosomal dominant]] inheritance
:*[criterion 2]
** Family history of [[gout]]
:*[criterion 3]
** A bland urinary sediment with little or no [[proteinuria]]
:*[criterion 4]
* One or both of the first two factors may be missing in patients with spontaneous [[mutations]], or if the family history is incomplete. In addition, a strong family history of [[gout]] may be absent in patients with a mutation in the MUC1 gene. It is important to include information about all family members as obtaining medical records from family members may be helpful.
* In patients with medullary cystic kidney disease, [[anemia]] beginning during childhood.
=== Symptoms ===
* Before the onset of severe renal dysfunction should raise suspicion for the presence of a REN gene mutation.
*[Disease name] is usually asymptomatic.
* Measurement of plasma [[renin]] and [[aldosterone]] is not usually helpful, since the levels of these hormones are highly variable depending upon volume status, posture, and stress.
*Symptoms of [disease name] may include the following:
Tests may include:
:*[symptom 1]
* 24-hour urine volume and [[Electrolyte|electrolytes]]
:*[symptom 2]
* [[Blood urea nitrogen]]  
:*[symptom 3]
* [[Creatinine]] blood test and [[creatinine clearance]]  
:*[symptom 4]
* Abdominal CT scan and abdominal ultrasound
:*[symptom 5]
* Renal  ultrasound and renal  biopsy
:*[symptom 6]
* Genetic testing of the UMOD gene
* Genetic testing of the REN gene
=== Physical Examination ===
* Genetic testing of the MUC1 gene
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]


=== Laboratory Findings ===
=== Fractional excretion of uric acid : ===
*There are no specific laboratory findings associated with [disease name].
Patients with UAKD or a REN gene mutation, but not patients with MUC1 mutations, should have [[hyperuricemia]] and a low fractional excretion of [[uric acid]]. The fractional excretion of uric acid (FEUA) can be calculated from a random urine specimen using the same formula used to calculate the fractional excretion of sodium, substituting uric acid for sodium using either standard units
 
* FEUA  =  (urine uric acid concentration  x  serum creatinine)  ÷  (urine creatinine concentration  x  serum uric acid)  Underexcretion is defined as an FEUA less than 6% and is often below 4% . Normal values in healthy adults are 8 ± 3 % in males and 13 ± 3 % in females.The normal fractional excretion of [[uric acid]] in healthy children is even higher (18 ± 5 percent).  One caveat is that the fractional excretion of uric acid and other solutes, such as sodium, increases as renal function worsens . The expected values for FEUA cited above only apply to patients with a [[glomerular filtration rate]] above 70 mL/min . Higher values would be seen at lower filtration rates.<ref name="pmid25818408">{{cite journal |vauthors=Suzuki T, Iyoda M, Yamaguchi Y, Shibata T |title=A case of sporadic medullary cystic kidney disease type 1 (MCKD1) with kidney enlargement complicated by IgA nephropathy |journal=Pathol. Int. |volume=65 |issue=7 |pages=379–82 |date=July 2015 |pmid=25818408 |doi=10.1111/pin.12292 |url=}}</ref>
*A  [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].
*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
   
   
== Treatment ==
== Treatment ==
=== Medical Therapy ===
*There is no cure for medullary cystic kidney disease. At first, treatment focuses on controlling symptoms, reducing complications, and slowing the progression of the disease.  
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*Patients who have gout are usually treated with [[allopurinol]]. It is unclear if lowering uric acid levels or initiating therapy with [[ACE inhibitor|angiotensin inhibitors]] prevents the progression of [[CKD]]. The management of [[CKD]] in patients with medullary cystic kidney disease is similar to that in patients with other causes of CKD .<ref name="pmid23475468">{{cite journal |vauthors=Soloukides AP, Moutzouris DA, Papagregoriou GN, Stavrou CV, Deltas CC, Tzanatos HA |title=Renal graft outcome in autosomal dominant medullary cystic kidney disease type 1 |journal=J. Nephrol. |volume=26 |issue=4 |pages=793–8 |date=2013 |pmid=23475468 |doi=10.5301/jn.5000249 |url=}}</ref>
 
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for [disease name].
*There are no primary preventive measures available for Medullary cystic kidney disease because it is an inherited disorder.It may not be preventable.
   
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].  
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 21:42, 27 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: nabeel ahmed

Overview

Medullary cystic kidney disease (MCKD) is an autosomal dominant kidney disorder characterized by tubulointerstitial sclerosis leading to end-stage renal disease autosomal dominant interstitial kidney disease (ADIKD) is a rare and heterogeneous genetic disorder. Medullary cystic kidney disease (MCKD) − MCKD is another term that has been used for ADIKD.

Classification

Medullary cystic kidney disease may be classified according to genetic mutation into:

  • Mutations in the UMOD gene, which encodes uromodulin are present in the majority of cases of ADIKD . This condition has also called uromodulin-associated kidney disease (UAKD) , medullary cystic kidney disease type 2 (MCKD2) and familial juvenile hyperuricemic nephropathy (FJHN) .
  • Mutations in the REN gene, which encodes renin.
  • Mutations in the MUC1 gene, which encodes mucin 1 ,called as medullary cystic kidney disease type 1 (MCKD1).[1]

Pathophysiology

  • Uromodulin associated kidney disease ( UAKD ) :
    • UAKD is due to mutations in the UMOD gene on chromosome 16p12, which encodes uromodulin (Tamm-Horsfall mucoprotein).
    • Missense mutation in exon 4 or 5 , it very rare mutation in exons 6 or 8.
    • Uromodulin is produced exclusively in the thick ascending limb of the loop of Henle. It is an insoluble protein whose sticky, adherent properties are probably important in maintaining the watertight integrity of the thick ascending limb.
    • Uromodulin also appears to facilitate intracellular transport of both the Na-K-2Cl furosemide-sensitive transporter and the ROMK potassium channel on the apical surface of the thick ascending loop tubular cells.
    • Intracellular accumulation of abnormal uromodulin proteins can lead to tubular cell atrophy and death.
    • The abnormal uromodulin appears to impair the synthesis and secretion of normal uromodulin produced from the unaffected allele, resulting in a marked reduction in urinary uromodulin excretion. [2]

There is two major pathophysiologic effects of uromodulin gene mutations: Hyperuricemia and progressive chronic kidney disease.

  • Hyperuricemia :
  • Mutations in the REN gene :

Epidemiology

Age

  • Patients of all age groups may develop medullary cystic kidney disease.
  • Medullary cystic kidney disease is more commonly observed among teenage years but end stage renal disease usually occurring between the ages of 20 and 70 years old.

Gender

  • Medullary cystic kidney disease affects men and women equally.
  • Male are more commonly affected with medullary cystic kidney disease than female.[5]

Risk Factors

Medullary cystic kidney disease (MCKD) is an autosomal dominant kidney disorder.

Differential diagnosis

For a list of diseases that should be differentiated from medullary cystic kidney disease, click here.

Complications and Prognosis

Medullary cystic kidney disease may lead to following health problems:[6]

Symptoms

Symptoms usually begin before the age of 20, but they vary great.

  • Excessive urination, caused by the reduced ability of the diseased kidneys to respond to antidiuretic (fluid-holding) hormone

Diagnosis

  • The diagnosis medullary cystic kidney disease suspected based upon clinical manifestations and the family history, and can be confirmed through genetic testing.
  • A presumptive clinical diagnosis of medullary cystic kidney disease in a young individual presenting with gout and chronic kidney disease relies upon three factors:
    • A strong family history of kidney disease in a pattern suggestive of autosomal dominant inheritance
    • Family history of gout
    • A bland urinary sediment with little or no proteinuria
  • One or both of the first two factors may be missing in patients with spontaneous mutations, or if the family history is incomplete. In addition, a strong family history of gout may be absent in patients with a mutation in the MUC1 gene. It is important to include information about all family members as obtaining medical records from family members may be helpful.
  • In patients with medullary cystic kidney disease, anemia beginning during childhood.
  • Before the onset of severe renal dysfunction should raise suspicion for the presence of a REN gene mutation.
  • Measurement of plasma renin and aldosterone is not usually helpful, since the levels of these hormones are highly variable depending upon volume status, posture, and stress.

Tests may include:

Fractional excretion of uric acid :

Patients with UAKD or a REN gene mutation, but not patients with MUC1 mutations, should have hyperuricemia and a low fractional excretion of uric acid. The fractional excretion of uric acid (FEUA) can be calculated from a random urine specimen using the same formula used to calculate the fractional excretion of sodium, substituting uric acid for sodium using either standard units

  • FEUA  =  (urine uric acid concentration  x  serum creatinine)  ÷  (urine creatinine concentration  x  serum uric acid) Underexcretion is defined as an FEUA less than 6% and is often below 4% . Normal values in healthy adults are 8 ± 3 % in males and 13 ± 3 % in females.The normal fractional excretion of uric acid in healthy children is even higher (18 ± 5 percent). One caveat is that the fractional excretion of uric acid and other solutes, such as sodium, increases as renal function worsens . The expected values for FEUA cited above only apply to patients with a glomerular filtration rate above 70 mL/min . Higher values would be seen at lower filtration rates.[7]

Treatment

  • There is no cure for medullary cystic kidney disease. At first, treatment focuses on controlling symptoms, reducing complications, and slowing the progression of the disease.
  • Patients who have gout are usually treated with allopurinol. It is unclear if lowering uric acid levels or initiating therapy with angiotensin inhibitors prevents the progression of CKD. The management of CKD in patients with medullary cystic kidney disease is similar to that in patients with other causes of CKD .[8]

Prevention

  • There are no primary preventive measures available for Medullary cystic kidney disease because it is an inherited disorder.It may not be preventable.

References

  1. Dahan K, Devuyst O, Smaers M, Vertommen D, Loute G, Poux JM, Viron B, Jacquot C, Gagnadoux MF, Chauveau D, Büchler M, Cochat P, Cosyns JP, Mougenot B, Rider MH, Antignac C, Verellen-Dumoulin C, Pirson Y (November 2003). "A cluster of mutations in the UMOD gene causes familial juvenile hyperuricemic nephropathy with abnormal expression of uromodulin". J. Am. Soc. Nephrol. 14 (11): 2883–93. PMID 14569098.
  2. Bleyer AJ, Trachtman H, Sandhu J, Gorry MC, Hart TC (August 2003). "Renal manifestations of a mutation in the uromodulin (Tamm Horsfall protein) gene". Am. J. Kidney Dis. 42 (2): E20–6. PMID 12900848.
  3. Williams SE, Reed AA, Galvanovskis J, Antignac C, Goodship T, Karet FE, Kotanko P, Lhotta K, Morinière V, Williams P, Wong W, Rorsman P, Thakker RV (August 2009). "Uromodulin mutations causing familial juvenile hyperuricaemic nephropathy lead to protein maturation defects and retention in the endoplasmic reticulum". Hum. Mol. Genet. 18 (16): 2963–74. doi:10.1093/hmg/ddp235. PMC 2714724. PMID 19465746.
  4. Zivná M, Hůlková H, Matignon M, Hodanová K, Vylet'al P, Kalbácová M, Baresová V, Sikora J, Blazková H, Zivný J, Ivánek R, Stránecký V, Sovová J, Claes K, Lerut E, Fryns JP, Hart PS, Hart TC, Adams JN, Pawtowski A, Clemessy M, Gasc JM, Gübler MC, Antignac C, Elleder M, Kapp K, Grimbert P, Bleyer AJ, Kmoch S (August 2009). "Dominant renin gene mutations associated with early-onset hyperuricemia, anemia, and chronic kidney failure". Am. J. Hum. Genet. 85 (2): 204–13. doi:10.1016/j.ajhg.2009.07.010. PMC 2725269. PMID 19664745.
  5. Simms RJ, Ong AC (September 2014). "How simple are 'simple renal cysts'?". Nephrol. Dial. Transplant. 29 Suppl 4: iv106–12. doi:10.1093/ndt/gfu106. PMC 4158337. PMID 25165175.
  6. Stanisić M, Hrvacević R, Paunić Z, Petrović S (September 2005). "[Nephronophthisis and medullary cystic kidney disease complex]". Vojnosanit Pregl. 62 (9): 683–8. PMID 16229212.
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