Skip to main content
Top
Published in: Clinical and Experimental Nephrology 5/2009

01-10-2009 | Case Report

Hemolytic uremic syndrome due to homozygous factor H deficiency

Authors: Sidharth Kumar Sethi, Dragon-Durey Marie-Agnes, Neelam Thaker, Pankaj Hari, Arvind Bagga

Published in: Clinical and Experimental Nephrology | Issue 5/2009

Login to get access

Abstract

The majority of complement factor H mutations associated with atypical hemolytic uremic syndrome (HUS) are heterozygous. Homozygous mutations causing atypical hemolytic uremic syndrome are rare. We report a 7-month-old boy with HUS, severe hypocomplementemia (low C3 and normal C4 levels), and extremely low circulating levels of factor H. Genetic analysis showed homozygous 4 bp deletion in the gene encoding factor H in the patient, with his parents being carriers. The patient showed progression to end-stage renal disease and is presently on chronic ambulatory peritoneal dialysis.
Literature
1.
2.
go back to reference Noris M, Ruggenenti P, Perna A, Orisio S, Caprioli J, Skerka C, et al. Hypocomplementemia discloses genetic predisposition to hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: role of factor H abnormalities. Italian Registry of Familial and Recurrent Hemolytic Uremic Syndrome/Thrombotic Thrombocytopenic Purpura. J Am Soc Nephrol. 1999;10:281–93.PubMed Noris M, Ruggenenti P, Perna A, Orisio S, Caprioli J, Skerka C, et al. Hypocomplementemia discloses genetic predisposition to hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: role of factor H abnormalities. Italian Registry of Familial and Recurrent Hemolytic Uremic Syndrome/Thrombotic Thrombocytopenic Purpura. J Am Soc Nephrol. 1999;10:281–93.PubMed
3.
go back to reference Caprioli J, Noris M, Brioschi S, Pianetti G, Castelletti F, Bettinaglio P, et al. International Registry of Recurrent and Familial HUS/TTP; Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood. 2006;108:1267–79.CrossRefPubMedPubMedCentral Caprioli J, Noris M, Brioschi S, Pianetti G, Castelletti F, Bettinaglio P, et al. International Registry of Recurrent and Familial HUS/TTP; Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood. 2006;108:1267–79.CrossRefPubMedPubMedCentral
4.
go back to reference Dragon-Durey MA, Frémeaux-Bacchi V, Loirat C, Blouin J, Niaudet P, Deschenes G, et al. Heterozygous and homozygous factor H deficiencies associated with hemolytic uremic syndrome or membranoproliferative glomerulonephritis: report and genetic analysis of 16 cases. J Am Soc Nephrol. 2004;15:787–95.CrossRefPubMed Dragon-Durey MA, Frémeaux-Bacchi V, Loirat C, Blouin J, Niaudet P, Deschenes G, et al. Heterozygous and homozygous factor H deficiencies associated with hemolytic uremic syndrome or membranoproliferative glomerulonephritis: report and genetic analysis of 16 cases. J Am Soc Nephrol. 2004;15:787–95.CrossRefPubMed
5.
go back to reference Pichette V, Quérin S, Schürch W, Brun G, Lehner-Netsch G, Delâge J. Familial hemolytic–uremic syndrome and homozygous factor H deficiency. Am J Kidney Dis. 1994;24:936–41.CrossRefPubMed Pichette V, Quérin S, Schürch W, Brun G, Lehner-Netsch G, Delâge J. Familial hemolytic–uremic syndrome and homozygous factor H deficiency. Am J Kidney Dis. 1994;24:936–41.CrossRefPubMed
6.
go back to reference Ohali M, Shalev H, Schlesinger M, Katz Y, Kachko L, Carmi R, et al. Hypocomplementemic autosomal recessive hemolytic uremic syndrome with decreased factor H. Pediat Nephrol. 1998;12:619–24.CrossRefPubMed Ohali M, Shalev H, Schlesinger M, Katz Y, Kachko L, Carmi R, et al. Hypocomplementemic autosomal recessive hemolytic uremic syndrome with decreased factor H. Pediat Nephrol. 1998;12:619–24.CrossRefPubMed
7.
go back to reference Kazatchkine MD, Hauptmann G, Nydegger U: Techniques de Complément, Paris, Société Française d’Immunologie 1985. Kazatchkine MD, Hauptmann G, Nydegger U: Techniques de Complément, Paris, Société Française d’Immunologie 1985.
8.
go back to reference Kazatchkine MD, Fearon DT, Austen KF. Human alternative complement pathway: membrane-associated sialic acid regulates the competition between B and β1 H for cell-bound C3b. J Immunol. 1979;122:75–81.PubMed Kazatchkine MD, Fearon DT, Austen KF. Human alternative complement pathway: membrane-associated sialic acid regulates the competition between B and β1 H for cell-bound C3b. J Immunol. 1979;122:75–81.PubMed
10.
go back to reference Vaziri-Sani F, Holmberg L, Sjöholm AG, Kristoffersson AC, Manea M, Frémeaux-Bacchi V, et al. Phenotypic expression of factor H mutations in patients with atypical hemolytic uremic syndrome. Kidney Int. 2006;69:981–8.CrossRefPubMed Vaziri-Sani F, Holmberg L, Sjöholm AG, Kristoffersson AC, Manea M, Frémeaux-Bacchi V, et al. Phenotypic expression of factor H mutations in patients with atypical hemolytic uremic syndrome. Kidney Int. 2006;69:981–8.CrossRefPubMed
11.
go back to reference Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA, Macher MA, Niaudet P, Guest G, et al. French Society of Pediatric Nephrology; differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2007;18:2392–400.CrossRefPubMed Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA, Macher MA, Niaudet P, Guest G, et al. French Society of Pediatric Nephrology; differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2007;18:2392–400.CrossRefPubMed
12.
go back to reference Schmidt BZ, Fowler NL, Hidvegi T, Perlmutter DH, Colten HR. Disruption of disulfide bonds is responsible for impaired secretion in human complement factor H deficiency. J Biol Chem. 1999;274:11782–8.CrossRefPubMed Schmidt BZ, Fowler NL, Hidvegi T, Perlmutter DH, Colten HR. Disruption of disulfide bonds is responsible for impaired secretion in human complement factor H deficiency. J Biol Chem. 1999;274:11782–8.CrossRefPubMed
13.
go back to reference Ault BH, Schmidt BZ, Fowler NL, Kashtan CE, Ahmed AE, Vogt BA, et al. Human factor H deficiency. Mutations in framework cysteine residues and block in H protein secretion and intracellular catabolism. J Biol Chem. 1997;272:25168–75.CrossRefPubMed Ault BH, Schmidt BZ, Fowler NL, Kashtan CE, Ahmed AE, Vogt BA, et al. Human factor H deficiency. Mutations in framework cysteine residues and block in H protein secretion and intracellular catabolism. J Biol Chem. 1997;272:25168–75.CrossRefPubMed
14.
go back to reference Edey MM, Mead PA, Saunders RE, Strain L, Perkins SJ, Goodship TH, et al. Association of a factor H mutation with hemolytic uremic syndrome following a diarrheal illness. Am J Kidney Dis. 2008;51:487–90.CrossRefPubMed Edey MM, Mead PA, Saunders RE, Strain L, Perkins SJ, Goodship TH, et al. Association of a factor H mutation with hemolytic uremic syndrome following a diarrheal illness. Am J Kidney Dis. 2008;51:487–90.CrossRefPubMed
15.
go back to reference Allford SL, Hunt BJ, Rose P, Machin SJ. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol. 2003;120:556–73.CrossRefPubMed Allford SL, Hunt BJ, Rose P, Machin SJ. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol. 2003;120:556–73.CrossRefPubMed
16.
go back to reference Saland JM, Emre SH, Shneider BL, Benchimol C, Ames S, Bromberg JS, et al. Favorable long-term outcome after liver–kidney transplant for recurrent hemolytic uremic syndrome associated with a factor H mutation. Am J Transplant. 2006;6:1948–52.CrossRefPubMed Saland JM, Emre SH, Shneider BL, Benchimol C, Ames S, Bromberg JS, et al. Favorable long-term outcome after liver–kidney transplant for recurrent hemolytic uremic syndrome associated with a factor H mutation. Am J Transplant. 2006;6:1948–52.CrossRefPubMed
17.
go back to reference Jalanko H, Peltonen S, Koskinen A, Puntila J, Isoniemi H, Holmberg C, et al. Successful liver–kidney transplantation in two children with aHUS caused by a mutation in complement factor H. Am J Transplant. 2008;8:216–21.PubMed Jalanko H, Peltonen S, Koskinen A, Puntila J, Isoniemi H, Holmberg C, et al. Successful liver–kidney transplantation in two children with aHUS caused by a mutation in complement factor H. Am J Transplant. 2008;8:216–21.PubMed
18.
go back to reference Thompson RA, Winterborn MH. Hypocomplementaemia due to a genetic deficiency of beta 1H globulin. Clin Exp Immunol. 1981;46:110–9.PubMedPubMedCentral Thompson RA, Winterborn MH. Hypocomplementaemia due to a genetic deficiency of beta 1H globulin. Clin Exp Immunol. 1981;46:110–9.PubMedPubMedCentral
19.
go back to reference Landau D, Shalev H, Levy-Finer G, Polonsky A, Segev Y, Katchko L. Familial hemolytic uremic syndrome associated with complement factor H deficiency. J Pediatr. 2001;138:412–7.CrossRefPubMed Landau D, Shalev H, Levy-Finer G, Polonsky A, Segev Y, Katchko L. Familial hemolytic uremic syndrome associated with complement factor H deficiency. J Pediatr. 2001;138:412–7.CrossRefPubMed
20.
go back to reference Caprioli J, Bettinaglio P, Zipfel PF, Amadei B, Daina E, Gamba S, et al. Italian Registry of Familial and Recurrent HUS/TTP; The molecular basis of familial hemolytic uremic syndrome: mutation analysis of factor H gene reveals a hot spot in short consensus repeat 20. J Am Soc Nephrol. 2001;12:297–307.PubMed Caprioli J, Bettinaglio P, Zipfel PF, Amadei B, Daina E, Gamba S, et al. Italian Registry of Familial and Recurrent HUS/TTP; The molecular basis of familial hemolytic uremic syndrome: mutation analysis of factor H gene reveals a hot spot in short consensus repeat 20. J Am Soc Nephrol. 2001;12:297–307.PubMed
21.
go back to reference Cho HY, Lee BS, Moon KC, Ha IS, Cheong HI, Choi Y. Complete factor H deficiency-associated atypical hemolytic uremic syndrome in a neonate. Pediatr Nephrol. 2007;22:874–80.CrossRefPubMed Cho HY, Lee BS, Moon KC, Ha IS, Cheong HI, Choi Y. Complete factor H deficiency-associated atypical hemolytic uremic syndrome in a neonate. Pediatr Nephrol. 2007;22:874–80.CrossRefPubMed
Metadata
Title
Hemolytic uremic syndrome due to homozygous factor H deficiency
Authors
Sidharth Kumar Sethi
Dragon-Durey Marie-Agnes
Neelam Thaker
Pankaj Hari
Arvind Bagga
Publication date
01-10-2009
Publisher
Springer Japan
Published in
Clinical and Experimental Nephrology / Issue 5/2009
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-009-0205-3

Other articles of this Issue 5/2009

Clinical and Experimental Nephrology 5/2009 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.