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Familial Hypomagnesemia with Hypercalciuria and Nephrocalcinosis Due to CLDN16 Gene Mutations: Novel Findings in Two Cases with Diverse Clinical Features

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dc.contributor.authorBEREKET, ABDULLAH
dc.contributor.authorsEltan, Mehmet; Abali, Zehra Yavas; Turkyilmaz, Ayberk; Gokce, Ibrahim; Abali, Saygin; Alavanda, Ceren; Arman, Ahmet; Kirkgoz, Tarik; Guran, Tulay; Hatun, Sukru; Bereket, Abdullah; Turan, Serap
dc.date.accessioned2022-03-14T09:55:13Z
dc.date.available2022-03-14T09:55:13Z
dc.date.issued2021-11-11
dc.description.abstractBiallelic loss of function mutations in the CLDN16 gene cause familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC), and chronic kidney disease. Here we report two cases of FHHNC with diverse clinical presentations and hypercalcemia in one as a novel finding. Pt#1 initially presented with urinary tract infection and failure to thrive at 5.5 months of age to another center. Bilateral nephrocalcinosis, hypercalcemia (Ca: 12.2 mg/dl), elevated parathyroid hormone (PTH) level, and hypercalciuria were detected. Persistently elevated PTH with high/normal Ca levels led to subtotal-parathyroidectomy at the age of 2.5. However, PTH levels remained elevated with progressive deterioration in renal function. At 9-year-old, she was referred to us for evaluation of hyperparathyroidism and, hypomagnesemia together with hypercalciuria, elevated PTH with normal Ca levels, and medullary nephrocalcinosis were detected. Compound heterozygosity of CLDN16 variants (c.715G>A, p.G239R; and novel c.360C>A, p.C120*) confirmed the diagnosis. Pt#2 was a 10-month-old boy, admitted with irritability and urinary crystals. Hypocalcemia, hypophosphatemia, elevated PTH and ALP, low 25(OH)D levels, and radiographic findings of rickets were detected. However, additional findings of hypercalciuria and bilateral nephrocalcinosis were inconsistent with the nutritional rickets. Low/normal serum Mg levels suggested the diagnosis of FHHNC which was confirmed genetically as a homozygous missense (c.602G > A; p.G201E) variant in CLDN16. Yet, hypocalcemia and hypomagnesemia persisted in spite of treatment. In conclusion, FHHNC may present with diverse clinical features with mild hypomagnesemia leading to secondary hyperparathyroidism with changing Ca levels from low to high. Early and accurate clinical and molecular genetic diagnosis is important for proper management.
dc.identifier.doi10.1007/s00223-021-00928-y
dc.identifier.eissn1432-0827
dc.identifier.issn0171-967X
dc.identifier.pubmed34761296
dc.identifier.urihttps://hdl.handle.net/11424/243653
dc.identifier.wosWOS:000716862000001
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofCALCIFIED TISSUE INTERNATIONAL
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCLDN16
dc.subjectClaudin 16
dc.subjectFamilial hypomagnesemia with hypercalciuria and nephrocalcinosis
dc.subjectFHHNC
dc.subjectHypomagnesemia
dc.subjectHypercalcemia
dc.subjectHyperparathyroidism
dc.subjectRickets
dc.subjectPARATHYROID-HORMONE SECRETION
dc.subjectCALCIUM
dc.subjectMAGNESIUM
dc.subjectRECEPTOR
dc.subjectCA2+
dc.subjectPARACELLIN-1
dc.subjectMECHANISMS
dc.subjectCLAUDIN-16
dc.titleFamilial Hypomagnesemia with Hypercalciuria and Nephrocalcinosis Due to CLDN16 Gene Mutations: Novel Findings in Two Cases with Diverse Clinical Features
dc.typearticle
dspace.entity.typePublication
local.avesis.id343fe372-aaee-436e-95b0-ee7f4964ff85
local.import.packageSS16
local.indexed.atWOS
local.indexed.atSCOPUS
local.indexed.atPUBMED
local.journal.numberofpages10
oaire.citation.titleCALCIFIED TISSUE INTERNATIONAL
relation.isAuthorOfPublication669e9474-4e39-453f-a4bc-4ede9cb5abac
relation.isAuthorOfPublication.latestForDiscovery669e9474-4e39-453f-a4bc-4ede9cb5abac

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