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中华移植杂志(电子版) ›› 2025, Vol. 19 ›› Issue (01) : 9 -15. doi: 10.3877/cma.j.issn.1674-3903.2025.01.002

所属专题: 经典病例

儿童肾移植

PAX2基因变异致Papillorenal综合征儿童肾移植四例
陈晓彬1, 聂晓晶1, 翁增凤1, 刘婧婧1, 黄隽1,()   
  1. 1. 350025 福州,中国人民解放军联勤保障部队第九〇〇医院儿科 福建医科大学福总临床医学院儿科 厦门大学附属东方医院儿科 福建中医药大学福总临床学院儿科
  • 收稿日期:2024-11-29 出版日期:2025-02-25
  • 通信作者: 黄隽
  • 基金资助:
    广东省医学科研基金(A2022250)广州市科技计划项目(2024A03J0191)

Analysis of kidney transplantation in four pediatric patients with Papillorenal syndrome caused by PAX2 gene variants

Xiaobin Chen1, Xiaojing Nie1, Zengfeng Weng1, Jingjing Liu1, Jun Huang1,()   

  1. 1. Department of Pediatrics, 900th Hospital of PLA Joint Logistic Support Force; Fuzong Clinical Medical College of Fujian Medical University; Affiliated Dongfang Hospital, Xiamen University; Fuzong Clinical Medical College, Fujian University of Traditional Chinese Medicine, Fuzhou 350025, China
  • Received:2024-11-29 Published:2025-02-25
  • Corresponding author: Jun Huang
引用本文:

陈晓彬, 聂晓晶, 翁增凤, 刘婧婧, 黄隽. PAX2基因变异致Papillorenal综合征儿童肾移植四例[J/OL]. 中华移植杂志(电子版), 2025, 19(01): 9-15.

Xiaobin Chen, Xiaojing Nie, Zengfeng Weng, Jingjing Liu, Jun Huang. Analysis of kidney transplantation in four pediatric patients with Papillorenal syndrome caused by PAX2 gene variants[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(01): 9-15.

目的

分析PAX2基因变异致Papillorenal综合征(PAPRS)患儿的临床表型和肾移植效果,探讨移植前风险评估和术后管理策略。

方法

回顾性分析2018年至2024年在中国人民解放军联勤保障部队第九〇〇医院确诊PAPRS后行肾移植治疗的4例患儿临床资料。记录基因变异类型、临床表现、术后并发症及相关多系统异常情况。

结果

4例患儿均携带PAX2基因(NM_000278.5)新发杂合变异,包括:c.221_226dup(p.E74_T75dup)、c.185A>G(p.H62R)(国内外均未见报道)和c.76dup(p.V26Gfs*28)(2例),这些变异位于热点突变结构域。患儿均为女性,在学龄期发现肾功能异常,进展为终末期肾病,青春期接受肾移植。术后均出现不同程度感染,并伴有肾外表现,包括眼部病变(如屈光不正、视野异常等)、生殖系统异常(如输卵管或卵巢病变)和中枢神经系统异常(如智力低下、情绪障碍等)。

结论

PAX2基因变异不仅影响肾功能,还可导致多系统受累,特别强调神经心理评估。早期心理干预有利于提高肾移植术后长期随访管理的依从性。

Objective

To analyze the clinical phenotypes and renal transplantation outcomes in children with Papillorenal syndrome (PAPRS) caused by PAX2 gene variations, and to propose strategies for pre-transplant risk assessment and post-transplant management strategies.

Methods

A retrospective analysis was performed on the clinical data of four pediatric patients diagnosed with PAPRS at 900th Hospital of PLA Joint Logistic Support Force between 2018 and 2024. These patients underwent kidney transplantation at other medical institutions and were subsequently followed up at our hospital. Clinical data, including genetic variant types, clinical manifestations, postoperative complications, and multi-system abnormalities, were systematically evaluated.

Results

All patients carried novel heterozygous variations in the PAX2 gene (NM_000278.5), including c.221_226dup(p.E74_T75dup), c.185A>G (p.H62R) (not previously reported in global or domestic databases),and c.76dup (p.V26Gfs*28) (two cases). These variations were located within a hotspot mutation domain. All patients were female and were diagnosed with abnormal renal function during school age,progressing to end-stage renal disease, leading to renal transplantation during adolescence.Postoperatively, all patients experienced varying degrees of infection and exhibited extrarenal manifestations, including ocular lesions such as refractive errors, visual field abnormalities,reproductive system abnormalities such as fallopian tube or ovarian lesions, and central nervous system abnormalities such as intellectual disability, mood disorders.

Conclusions

Variations in the PAX2 gene not only impair renal function, but also result in multi-systemic involvement, with a particular focus on neuropsychological assessment. Early psychological intervention is conducive to improving adherence to long-term follow-up management after renal transplantation.

图1 病例1影像学检查结果 注: a.腹部CT; b.右侧眼底,箭头示视乳头色苍白、后极部大片视网膜萎缩灶; c.左侧眼底,箭头示左眼视杯轻度增大; d.右眼磁共振,箭头示框内占位性病变; e.脊柱X线片示胸段脊柱侧弯畸形; f.手指X线片,箭头示左手指骨骨密度降低伴屈曲畸形
图2 病例2影像学检查结果 注: a.右侧眼底,箭头示视乳头增大、视盘凹陷; b.左侧眼底,箭头示左侧视盘周围视网膜脉络膜缺失、视盘增大,较右侧为著; c.光层相干断层扫描,箭头示右眼黄斑区偏鼻侧神经上皮囊样水肿增厚,视杯增大,视网膜劈裂; d.全脊柱X线片示胸椎脊柱侧弯畸形
图3 病例3影像学检查结果 注: a.腹部CT示双肾萎缩; b.右侧眼底,箭头示视乳头色素沉着; c.左侧眼底,箭头示视乳头色素轻度沉着、动静脉血管弓夹角变小;d.脊柱X线片示腰段脊柱侧弯
图4 病例4影像学检查结果 注: a.腹部CT,箭头示双肾体积小; b.头颅磁共振,箭头示枕大池蛛网膜囊肿; c.腹部超声,箭头示左侧卵巢囊肿; d.脊柱X线片示颈椎生理曲度轻度反弓、腰段脊柱侧弯
图5 4例PAX2基因变异致PAPRS肾移植患儿家系图及一代验证图
表1 4例PAX2基因变异致Papillorenal综合征肾移植患儿临床资料及基因信息
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