Clinical and Laboratory Evaluation of Cystinotic Patients Admitted at Mofid and Labafinejad Hospitals (In Tehran) and Abuzar Children’s Hospital in Ahvaz

Document Type : Original Article

Authors

1 Department of Pediatric Nephrology Division, Abuzar Children`s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Intern, Mofid Children`s Hospital, Shahid-Behashti University of Medical Sciences, Tehran, Iran.

Abstract

Background and Objective: Cystinosis is a rare autosomal recessive disorder caused by accumulation of cystine in different organs. Infantile cystinosis characterized by Fanconi syndrome and growth retardation leading to renal failure. The aim of the study was to evaluate the clinical and laboratory findings of cystinotic patients attending at Mofid, Labafinejad hospitals (in Tehran) and Abuzar children’s hospital (in Ahvaz), Iran.
Subjects and Methods: During 1995-2010, all children with cystinosis hospitalized at the above three centers were enrolled. Patients with the following criteria were considered as cases of cystinosis: i) signs and symptoms of Fanconi syndrome ii) Presence of cystine crystals in cornea using slit lamp.
Results: Of all the subjeces, 44 children fulfilled the criteria of nephropathic cystinosis. There were 24 (54.05%) females and 20 (45.5%) males. Among them, 21 (47.7%) cases were Arabs. The mean age of onset of symptoms was 8 (range 3-18) months. The mean age at the initial presentation of chronic renal failure was 3 years. The most common clinical features in the patients were growth retardation (100%), presence of cystine crystal in cornea(100%), rickets(86%) and polyuria-polydipsia (83%). The commonest laboratory data were glucosuria (100%), renal tubular acidosis (97%), proteinuria (88.5%) and hyposthenuria (82%). Sixteen (36.3%) of the 44 patients received kidney transplant, of which 7 (43.7%) patients rejected their grafts. Finally, 13 (29.5%) of them were relatively good on medical treatment, 8 (18.1%) died, 2 (4.5%) on waiting list of kidney transplant and 21 (47.7%) missed follow up.
Conclusion: Although cystinosis is a rare disease in the world, it seems to be a relatively common hereditary disease with unfavorable prognosis in Iranian Arabs.
Sci Med J 2011;10(5):535-43
 

Keywords


 
1- Town M, Jean G, Cherqui S, Attard M, Forestier L, White more SA, et al. A novel gene encoding an integral membrane protein is mutated in nephropatic cystinosis. Nature Genet. 1998; 18(4): 319-24. [PMID: 9537412]
2- Gahl WA. Cystinosis. In: Avener ED, Harmon WE, Niadet P, Yoshikawa N (eds). Pediatric Nephrology, 6th ed. Berlin: Spriner-Verlag; 2009: p.1020-5.
3- Mc Dowell GA, Gahl WA, Stephenson. Linkage of the gene for cystinosis to markers on the short arm of chromosome 17. Nature Gent. 1995; 10: 246-248. [PMID:7663525]
4- Touchman JW, Anikser Y, Dietrich NL. The genomic region encompassing the nephropathic cystiniosis gene (CTNS): complete sequencing of a 200- kb segment and discovery of a novel gene within the common cystinosis- causing deletion. Genome Res. 2000; 10(2): 165-73. [PMID: 10673275]
5- Van’t Hoff W. Cystinos Symposium, in Abstract book. 36th ESPN meeting Sep 2002, Bilbao, Spain.
6- Haq S, Hoff  WV. Cellular dysfunction in cystinosis. In: Broyer  M (ed). Cystinosis, firsted. Paris: Elsevier; 1999: p.14-18.
7- Madani K, Otoukash H, Rastegar A, Why SV. Chronic Renal Failure in Iranian children. Pediatr Nephrol. 2001; 16(2): 120-44. [PMID: 11261681]
8- Ahmadzadeh A, Valavi E, Zanganeh- Kamali M, Ahmadzadeh A. Chronic kidney disease in the South Western Iranian children. Iranian Journal of Pediatric. 2009; 19(2): 147-152.
9- Collin S. Hoff  WV. UK cystinosis registry (in Abstract of 3rd International conference). J Inhert Metab Dis. 2005; 28: 1211-12.
10-  Durea P, Huard C, Dufier JL. Cystinosis: Ocular manifestations. In: Broyer M. Cystinosis. 1st ed. Paris: Elsevier; 1999: p. 49-55.
11-  Mirdehghan M, Ahmadzadeh A, Bana- Behbahani M, Motlegh I, Chomeili B. Infantile cystinosis. Indian Pediatr. 2003; 40(1): 21-3. [PMID: 12554913]
12-  Otoukesh H. Nephropathic cystinosis, Abstract book, Annual congress of Iranian society of pediatrics. Tehran, Iran, 1996: 264-66 (in Persian).
13-  Sahka K. Cystinosis-Case report, Abstract book, 8th International congress of pediatrics, Tehran University of Medical Sciences, Tehran, Iran, 1996: 345-55 (in Persian).
14-  Cochat P, Cordier C, Said MH. Cystinosis: epidemiology in France. In: Broyer M. Cystinosis. 1st ed. Paris: Elsevier; 1999: p. 28-35.
15-  Rigden SA. Data from the ERA- EDTA registry. In: Broyer M. Cystinosis. 1st ed. Paris: Elsevier; 1999: p. 20- 7.
16- Soliman NA, El-Baroudy R, Rizk A, Bazaraa H, Younan A. Nephropathic Cystinosis in Children: An Overlooked Disease. Saudi J Kidney Dis Transpl. 2009; 20(3): 436-42. [PMID: 19414947]