The term CAKUT has outlived its usefulness:the case for the defense

Congenital anomalies of the kidney and urinary tract form a spectrum of congenital structural disorders that are generally known under the term CAKUT. The term CAKUT was introduced 20 years ago and has been used extensively in literature since. Prof. Woolf has made a plea for abandoning this term in his "case for the prosecution." Here, I advocate for the continued use of CAKUT as an umbrella term for these related congenital kidney and urinary tract abnormalities. I explain why the term CAKUT accurately and usefully defines this group of related structural disorders with prenatal origin and why it makes sense to continue grouping these disorders given accumulating evidence for shared etiology of CAKUT phenotypes and the importance of grouping CAKUT phenotypes in genetic counseling

Inherited Disorders of Water Handling

Under normal circumstances, about 90% of the 180 L/day glomerular filtrate is constitutively reabsorbed in the proximal tubule and descending limb of Henle’s loop. According to the needs, the remaining 10% of the fluid is reabsorbed in the collecting duct by a tightly regulated process under control of arginine vasopressin (AVP). After binding of AVP to arginine vasopressin type 2 receptors (AVPR2) in the basolateral membrane of collecting duct cells, aquaporin-2 (AQP2) water channels are inserted into the luminal membrane of these cells, allowing water reabsorption and urine concentration. Disorders of water handling are characterized by disturbances of this AVP-regulated system. In congenital nephrogenic diabetes insipidus (NDI), the kidney cannot concentrate urine in response to AVP, as a result of loss-of-function mutations in genes encoding AVPR2 and AQP2, resulting in polyuria and polydipsia. In recent years, extensive research has led to increased understanding of the cellular defects in NDI, with important implications for future development of targeted treatment of the disorder, with hope for better outcomes in comparison to the conventional symptomatic therapy. The very rare nephrogenic syndrome of inappropriate antidiuresis (NSIAD), caused by gain-of-function mutations in the gene encoding AVPR2, is the mirror image of NDI. In this disorder, urinary dilution is impaired, independent of the presence or absence of AVP. In this chapter, the focus will be on the physiology of water handling in the collecting duct and on its disturbances in congenital NDI. The clinical details, differential diagnosis, genetics, and conventional and possible future therapies of NDI will be discussed in detail.</p

Clinical versus research genomics in kidney disease

Key differences exist between clinical and research genomics. As genomic testing is adopted in nephrology clinical care, we propose focusing on clinical genomics approaches to obtain genetic diagnoses in order to ensure optimal use of resources and maximum patient benefit

Clinical Integration of Genome Diagnostics for Congenital Anomalies of the Kidney and Urinary Tract

Revolutions in genetics, epigenetics, and bioinformatics are currently changing the outline of diagnostics and clinical medicine. From a nephrologist's perspective, individuals with congenital anomalies of the kidney and urinary tract (CAKUT) are an important patient category: not only is CAKUT the predominant cause of kidney failure in children and young adults, but the strong phenotypic and genotypic heterogeneity of kidney and urinary tract malformations has hampered standardization of clinical decision making until now. However, patients with CAKUT may benefit from precision medicine, including an integrated diagnostics trajectory, genetic counseling, and personalized management to improve clinical outcomes of developmental kidney and urinary tract defects. In this review, we discuss the present understanding of the molecular etiology of CAKUT and the currently available genome diagnostic modalities in the clinical care of patients with CAKUT. Finally, we discuss how clinical integration of findings from large-scale genetic, epigenetic, and gene-environment interaction studies may improve the prognosis of all individuals with CAKUT

Drug Repurposing for Rare Diseases

Currently, there are about 7000 identified rare diseases, together affecting 10% of the population. However, fewer than 6% of all rare diseases have an approved treatment option, highlighting their tremendous unmet needs in drug development. The process of repurposing drugs for new indications, compared with the development of novel orphan drugs, is a time-saving and cost-efficient method resulting in higher success rates, which can therefore drastically reduce the risk of drug development for rare diseases. Although drug repurposing is not novel, new strategies have been developed in recent years to do it in a systematic and rational way. Here, we review applied methodologies, recent accomplished progress, and the challenges associated in drug repurposing for rare diseases

Author's Reply:The Subcellular Localization of RRAGD

peer reviewe

Diagnostic Yield of Next-Generation Sequencing in Patients With Chronic Kidney Disease of Unknown Etiology

Advances in next-generation sequencing (NGS) techniques, including whole exome sequencing, have facilitated cost-effective sequencing of large regions of the genome, enabling the implementation of NGS in clinical practice. Chronic kidney disease (CKD) is a major contributor to global burden of disease and is associated with an increased risk of morbidity and mortality. CKD can be caused by a wide variety of primary renal disorders. In about one in five CKD patients, no primary renal disease diagnosis can be established. Moreover, recent studies indicate that the clinical diagnosis may be incorrect in a substantial number of patients. Both the absence of a diagnosis or an incorrect diagnosis can have therapeutic implications. Genetic testing might increase the diagnostic accuracy in patients with CKD, especially in patients with unknown etiology. The diagnostic utility of NGS has been shown mainly in pediatric CKD cohorts, while emerging data suggest that genetic testing can also be a valuable diagnostic tool in adults with CKD. In addition to its implications for unexplained CKD, NGS can contribute to the diagnostic process in kidney diseases with an atypical presentation, where it may lead to reclassification of the primary renal disease diagnosis. So far, only a few studies have reported on the diagnostic yield of NGS-based techniques in patients with unexplained CKD. Here, we will discuss the potential diagnostic role of gene panels and whole exome sequencing in pediatric and adult patients with unexplained and atypical CKD

Effect of posttranslational modification on the Na+, K+ ATPase kinetics

The Na+, K+ ATPase is an essential membrane protein in eukaryotic cells, which transports Na+ out of the cell in exchange for K+ into the cell. For this transport it hydrolyses one molecule of ATP for each cycle. The partial reactions of the ATPase cycle and the effects of posttranslational modifications on ATPase activity have been studied extensively. However, amalgamation of the reported rate constants for the partial reactions along with the effect of posttranslational modifications have never been attempted. We have designed a simplified four-state mathematical model of the Na+, K+ ATPase using published results for the partial reactions. We have incorporated the effect of the Na+ allosteric site and poise dependent glutathionylation and attempted to replicate K+ activated transient currents reported in voltage clamped cardiomyocytes. Our voltage clamped cardiomyocyte results indicate the K+ activated transient is an effect of poise dependent glutathionylation rather than the Na+ subsarcolemmal space. These results can be replicated to some extent by the proposed kinetic model. This is the first kinetic model of the Na+, K+ ATPase that incorporates both partial rate constants and a reported posttranslational modification which is able to reproduce voltage clamped cardiomyocyte data