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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. 584–8. doi:10.1002/ajmg.a.31634. PMID 17318842.
^ a b c Goulet O, Vinson C, Roquelaure B, Brousse N, Bodemer C, Cézard JP (2008). "Syndromic (phenotypic) diarrhea in early infancy". Orphanet J Rare Dis. 3: 6. doi:10.1186/1750-1172-3-6. PMC 2279108. PMID 18304370.
^ Verloes A, Lombet J, Lambert Y, et al. (February 1997). "Tricho-hepato-enteric syndrome: further delineation of a distinct syndrome with neonatal hemochromatosis phenotype, intractable diarrhea, and hair anomalies". Am. J. Med. Genet. 68 (4): 391–5. | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. 1186/1750-1172-3-6. PMC 2279108. PMID 18304370.
^ Verloes A, Lombet J, Lambert Y, et al. (February 1997). "Tricho-hepato-enteric syndrome: further delineation of a distinct syndrome with neonatal hemochromatosis phenotype, intractable diarrhea, and hair anomalies". Am. J. Med. Genet. 68 (4): 391–5. doi:10.1002/(SICI)1096-8628(19970211)68:4<391::AID-AJMG3>3.0.CO;2-P. PMID 9021008.
^ Fabre A, Martinez-Vinson C, Roquelaure B, Missirian C, André N, Breton A, Lac | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. . 68 (4): 391–5. doi:10.1002/(SICI)1096-8628(19970211)68:4<391::AID-AJMG3>3.0.CO;2-P. PMID 9021008.
^ Fabre A, Martinez-Vinson C, Roquelaure B, Missirian C, André N, Breton A, Lachaux A, Odul E, Colomb V, Lemale J, Cézard JP, Goulet O, Sarles J, Levy N, Badens C (2011). "Novel mutations in TTC37 associated with tricho-hepato-enteric syndrome" (PDF). Hum Mutat. 32 (3): 277–281. doi:10.1002/humu.21420. PM | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. C, André N, Breton A, Lachaux A, Odul E, Colomb V, Lemale J, Cézard JP, Goulet O, Sarles J, Levy N, Badens C (2011). "Novel mutations in TTC37 associated with tricho-hepato-enteric syndrome" (PDF). Hum Mutat. 32 (3): 277–281. doi:10.1002/humu.21420. PMID 21120949.CS1 maint: multiple names: authors list (link)
^ Vardi I, Barel O, Sperber M, Schvimer M, Nunberg M, Field M, Ouahed J, Marek-Yagel D, Werner L, Haberman Y, Lahad A, Anikster Y, Rechavi G, Barshack I, McEl | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. .1002/humu.21420. PMID 21120949.CS1 maint: multiple names: authors list (link)
^ Vardi I, Barel O, Sperber M, Schvimer M, Nunberg M, Field M, Ouahed J, Marek-Yagel D, Werner L, Haberman Y, Lahad A, Anikster Y, Rechavi G, Barshack I, McElwee JJ, Maranville J, Somech R, Snapper SB, Weiss B, Shouval DS (May 2018). "Genetic and Structural Analysis of a SKIV2L Mutation Causing Tricho-hepato-enteric Syndrome". Dig Dis Sci. 63 (5): 1192–1199. doi:10.1007/s10620-018-4983-x. | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. Rechavi G, Barshack I, McElwee JJ, Maranville J, Somech R, Snapper SB, Weiss B, Shouval DS (May 2018). "Genetic and Structural Analysis of a SKIV2L Mutation Causing Tricho-hepato-enteric Syndrome". Dig Dis Sci. 63 (5): 1192–1199. doi:10.1007/s10620-018-4983-x. PMC 6167312. PMID 29484573.CS1 maint: multiple names: authors list (link)
^ Hartley JL, Zachos NC, Dawood B, Donowitz M, Forman J, Pollitt RJ, Morgan NV, Tee L, Gissen P, Kahr WH, Knisely AS, Watson S, Chitayat D, Booth IW | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. s10620-018-4983-x. PMC 6167312. PMID 29484573.CS1 maint: multiple names: authors list (link)
^ Hartley JL, Zachos NC, Dawood B, Donowitz M, Forman J, Pollitt RJ, Morgan NV, Tee L, Gissen P, Kahr WH, Knisely AS, Watson S, Chitayat D, Booth IW, Protheroe S, Murphy S, de Vries E, Kelly DA, Maher ER (2010). "Mutations in TTC37 cause trichohepatoenteric syndrome (phenotypic diarrhea of infancy)". Gastroenterology. 138 (7): 2388–2398. doi:10.1053/j.gastro.2010.02.010. PMC 3166659. PMID 20176027 | [
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. S, Chitayat D, Booth IW, Protheroe S, Murphy S, de Vries E, Kelly DA, Maher ER (2010). "Mutations in TTC37 cause trichohepatoenteric syndrome (phenotypic diarrhea of infancy)". Gastroenterology. 138 (7): 2388–2398. doi:10.1053/j.gastro.2010.02.010. PMC 3166659. PMID 20176027.CS1 maint: multiple names: authors list (link)
^ Fabre, A., Martinez-Vinson, C., Goulet, O. et al. Syndromic diarrhea/Tricho-hepato-enteric syndrome. Orphanet J Rare Dis 8, 5 (2013). https://doi.org/10.1186/1750-1172-8-5
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] |
wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. PMC 3166659. PMID 20176027.CS1 maint: multiple names: authors list (link)
^ Fabre, A., Martinez-Vinson, C., Goulet, O. et al. Syndromic diarrhea/Tricho-hepato-enteric syndrome. Orphanet J Rare Dis 8, 5 (2013). https://doi.org/10.1186/1750-1172-8-5
^ Girault D, Goulet O, Le Deist F, et al. (July 1994). "Intractable infant diarrhea associated with phenotypic abnormalities and immunodeficiency". J. Pediatr. 125 (1): 36–42. doi:10.1016/S0022-3476(94)70118-0. PMID 8021782.
^ Stankler L, Lloyd D, Pollitt RJ | [
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] |
wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. 0-1172-8-5
^ Girault D, Goulet O, Le Deist F, et al. (July 1994). "Intractable infant diarrhea associated with phenotypic abnormalities and immunodeficiency". J. Pediatr. 125 (1): 36–42. doi:10.1016/S0022-3476(94)70118-0. PMID 8021782.
^ Stankler L, Lloyd D, Pollitt RJ, Gray ES, Thom H, Russell G (March 1982). "Unexplained diarrhoea and failure to thrive in 2 siblings with unusual facies and abnormal scalp hair shafts: a new syndrome". Arch. Dis. Child. 57 (3): 212–6. doi:10.1136/adc.57.3.212. PMC 1627586. PMID 7073301.
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. L, Lloyd D, Pollitt RJ, Gray ES, Thom H, Russell G (March 1982). "Unexplained diarrhoea and failure to thrive in 2 siblings with unusual facies and abnormal scalp hair shafts: a new syndrome". Arch. Dis. Child. 57 (3): 212–6. doi:10.1136/adc.57.3.212. PMC 1627586. PMID 7073301.
References
Goulet O, Vinson C, Roquelaure B, Brousse N, Bodemer C, Cézard JP (2008). "Syndromic (phenotypic) diarrhea in early infancy". Orphanet J Rare Dis. 3: 6. doi:10.1186/1750-1172-3-6. PMC 2279108. PMID 18304370.
External links
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. . PMID 7073301.
References
Goulet O, Vinson C, Roquelaure B, Brousse N, Bodemer C, Cézard JP (2008). "Syndromic (phenotypic) diarrhea in early infancy". Orphanet J Rare Dis. 3: 6. doi:10.1186/1750-1172-3-6. PMC 2279108. PMID 18304370.
External links
ClassificationDOMIM: 222470External resourcesOrphanet: 84064
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] |
wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. 18304370.
External links
ClassificationDOMIM: 222470External resourcesOrphanet: 84064
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. /1000000
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. : 6229126/52428800 bytes
Number of Wikibase entities loaded: 1/400
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. .835 10 Template:Fix
22.53% 106.583 2 Template:Infobox
20.29% 96.009 1 Template:Infobox_medical_condition_(new)
15.45% 73.080 20 Template:Category_handler
10.48% 49.596 10 Template:Delink
9.14% 43.243 1 Template:Medical_resources
4.95% 23.404 2 Template:Hlist
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wikipedia | https://en.wikipedia.org/wiki/Tricho-hepato-enteric_syndrome | 6Dm1ALx | Tricho-hepato-enteric syndrome | C1857276 | 15 | tricho-hepato-enteric syndrome. 2 Template:Hlist
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. SummaryClinical characteristics.Primary hyperoxaluria type 2 (PH2), caused by deficiency of the enzyme glyoxylate reductase/hydroxypyruvate reductase (GR/HPR), is characterized by recurrent nephrolithiasis (deposition of calcium oxalate in the renal pelvis/urinary tract), nephrocalcinosis (deposition of calcium oxalate in the renal parenchyma), and end-stage renal disease (ESRD). After ESRD, oxalosis (widespread tissue deposition of calcium oxalate) usually develops. Symptom onset is typically in childhood.Diagnosis/testing.The diagnosis of PH2 is established in a proband by identification of biallelic pathogenic variants in GRHPR by molecular genetic testing. If no pathogenic variants or only one pathogenic variant is identified by molecular genetic testing, identification of reduced glyoxylate reductase enzyme activity on liver biopsy can establish the diagnosis of PH2.Management.Treatment of manifestations: Reduction of urinary calcium oxalate supersaturation through adequate daily fluid intake and | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. of calcium oxalate) usually develops. Symptom onset is typically in childhood.Diagnosis/testing.The diagnosis of PH2 is established in a proband by identification of biallelic pathogenic variants in GRHPR by molecular genetic testing. If no pathogenic variants or only one pathogenic variant is identified by molecular genetic testing, identification of reduced glyoxylate reductase enzyme activity on liver biopsy can establish the diagnosis of PH2.Management.Treatment of manifestations: Reduction of urinary calcium oxalate supersaturation through adequate daily fluid intake and treatment with inhibitors of calcium oxalate crystallization (orthophosphate, potassium citrate, and magnesium); temporary intensive dialysis for ESRD, followed by transplantation.Surveillance: Biannual assessment of renal function, urinalysis with measurements of urine oxalate excretion (using 24-hour collection if easy to facilitate or spot urine oxalate to creatinine ratio), and calcium oxalate saturation if available, blood pressure, and full blood count including hematocrit; assessment of renal stone burden | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. oxalate supersaturation through adequate daily fluid intake and treatment with inhibitors of calcium oxalate crystallization (orthophosphate, potassium citrate, and magnesium); temporary intensive dialysis for ESRD, followed by transplantation.Surveillance: Biannual assessment of renal function, urinalysis with measurements of urine oxalate excretion (using 24-hour collection if easy to facilitate or spot urine oxalate to creatinine ratio), and calcium oxalate saturation if available, blood pressure, and full blood count including hematocrit; assessment of renal stone burden every six to 12 months by urinary tract imaging (renal ultrasound or CT); assessment of cardiac, skin, bone, joint, eye, thyroid, and hematologic involvement annually after progression to ESRD.Agents/circumstances to avoid: Dehydration. Ascorbate (vitamin C) ingestion and foods rich in oxalate (chocolate, rhubarb, and star fruit) may cause additional minimal increase in urinary oxalate levels in select individuals; excess should be discouraged; | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. count including hematocrit; assessment of renal stone burden every six to 12 months by urinary tract imaging (renal ultrasound or CT); assessment of cardiac, skin, bone, joint, eye, thyroid, and hematologic involvement annually after progression to ESRD.Agents/circumstances to avoid: Dehydration. Ascorbate (vitamin C) ingestion and foods rich in oxalate (chocolate, rhubarb, and star fruit) may cause additional minimal increase in urinary oxalate levels in select individuals; excess should be discouraged; high salt (sodium) diet should be discouraged; excessive stone interventions with extracorporal shock wave lithotripsy.Evaluation of relatives at risk: For asymptomatic at-risk relatives offer urine analysis and, if indicated by the results of urine analysis, molecular genetic testing (if the pathogenic variants in the family are known) so that early diagnosis can inform treatment.Genetic counseling.PH2 is inherited in an autosomal recessive manner. Each sib of an affected individual has a | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. select individuals; excess should be discouraged; high salt (sodium) diet should be discouraged; excessive stone interventions with extracorporal shock wave lithotripsy.Evaluation of relatives at risk: For asymptomatic at-risk relatives offer urine analysis and, if indicated by the results of urine analysis, molecular genetic testing (if the pathogenic variants in the family are known) so that early diagnosis can inform treatment.Genetic counseling.PH2 is inherited in an autosomal recessive manner. Each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk family members and prenatal testing for pregnancies at increased risk are possible if the pathogenic variants in the family are known.DiagnosisSuggestive FindingsPrimary hyperoxaluria type 2 (PH2) should be suspected in individuals with the following clinical and laboratory features.Clinical featuresS | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. . Each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk family members and prenatal testing for pregnancies at increased risk are possible if the pathogenic variants in the family are known.DiagnosisSuggestive FindingsPrimary hyperoxaluria type 2 (PH2) should be suspected in individuals with the following clinical and laboratory features.Clinical featuresSymptoms of nephrolithiasis (e.g., hematuria, renal colic, obstruction of the urinary tract)Frequent recurrent nephrolithiasisNephrocalcinosisEnd-stage renal disease with a history of nephrolithiasisLaboratory featuresKidney stone analysis. Kidney stones containing predominantly calcium oxalateIncreased urinary oxalate, typically greater than 0.7 mmol/1.73 m2/24h (normal <0.46 | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. following clinical and laboratory features.Clinical featuresSymptoms of nephrolithiasis (e.g., hematuria, renal colic, obstruction of the urinary tract)Frequent recurrent nephrolithiasisNephrocalcinosisEnd-stage renal disease with a history of nephrolithiasisLaboratory featuresKidney stone analysis. Kidney stones containing predominantly calcium oxalateIncreased urinary oxalate, typically greater than 0.7 mmol/1.73 m2/24h (normal <0.46 mmol/1.73 m2/24h). A 24-hour collection in acid is preferable to a random sample.Increased urinary L-glycerate. This analyte may be detected on an organic acid screen, but there is considerable variability between methods and a specific method for glycerate is preferable.Increased plasma oxalate. After the onset of renal failure, measurement of plasma oxalate concentration may be helpful. In contrast to the elevated plasma oxalate concentrations in persons with renal | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. 24h (normal <0.46 mmol/1.73 m2/24h). A 24-hour collection in acid is preferable to a random sample.Increased urinary L-glycerate. This analyte may be detected on an organic acid screen, but there is considerable variability between methods and a specific method for glycerate is preferable.Increased plasma oxalate. After the onset of renal failure, measurement of plasma oxalate concentration may be helpful. In contrast to the elevated plasma oxalate concentrations in persons with renal failure from other causes, plasma oxalate concentrations in individuals with primary hyperoxaluria with glomerular filtration rate lower than 20 mL/min/1.73 m2 often exceed 50 μmol/L.Establishing the DiagnosisThe diagnosis of PH2 is established in a proband by identification of biallelic pathogenic variants in GRHPR by molecular genetic testing (see Table 1). If no pathogenic variants or only one pathogenic variant is identified by molecular genetic testing, identification of reduced | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. the elevated plasma oxalate concentrations in persons with renal failure from other causes, plasma oxalate concentrations in individuals with primary hyperoxaluria with glomerular filtration rate lower than 20 mL/min/1.73 m2 often exceed 50 μmol/L.Establishing the DiagnosisThe diagnosis of PH2 is established in a proband by identification of biallelic pathogenic variants in GRHPR by molecular genetic testing (see Table 1). If no pathogenic variants or only one pathogenic variant is identified by molecular genetic testing, identification of reduced glyoxylate reductase enzyme activity on a liver biopsy can establish the diagnosis of PH2.Molecular genetic testing approaches can include single-gene testing and use of a multigene panel:Single-gene testing. Sequence analysis of GRHPR is performed first and may be followed by gene-targeted deletion/duplication analysis if only one or no pathogenic variant is found.A multigene panel that includes GRHPR and other genes of interest (see Differential Diagnosis) | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. identified by molecular genetic testing, identification of reduced glyoxylate reductase enzyme activity on a liver biopsy can establish the diagnosis of PH2.Molecular genetic testing approaches can include single-gene testing and use of a multigene panel:Single-gene testing. Sequence analysis of GRHPR is performed first and may be followed by gene-targeted deletion/duplication analysis if only one or no pathogenic variant is found.A multigene panel that includes GRHPR and other genes of interest (see Differential Diagnosis) may be considered. Note: (1) The genes included in the panel and the diagnostic sensitivity of the testing used for each gene vary by laboratory and are likely to change over time. (2) Some multigene panels may include genes not associated with the condition discussed in this GeneReview; thus, clinicians need to determine which multigene panel is most likely to identify the genetic cause of the condition at the most reasonable cost while limiting identification of variants | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. other genes of interest (see Differential Diagnosis) may be considered. Note: (1) The genes included in the panel and the diagnostic sensitivity of the testing used for each gene vary by laboratory and are likely to change over time. (2) Some multigene panels may include genes not associated with the condition discussed in this GeneReview; thus, clinicians need to determine which multigene panel is most likely to identify the genetic cause of the condition at the most reasonable cost while limiting identification of variants of uncertain significance and pathogenic variants in genes that do not explain the underlying phenotype. (3) In some laboratories, panel options may include a custom laboratory-designed panel and/or custom phenotype-focused exome analysis that includes genes specified by the clinician. (4) Methods used in a panel may include sequence analysis, deletion/duplication analysis, and/or other non-sequencing-based tests.For an introduction to multigene panels click here. More detailed | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. the most reasonable cost while limiting identification of variants of uncertain significance and pathogenic variants in genes that do not explain the underlying phenotype. (3) In some laboratories, panel options may include a custom laboratory-designed panel and/or custom phenotype-focused exome analysis that includes genes specified by the clinician. (4) Methods used in a panel may include sequence analysis, deletion/duplication analysis, and/or other non-sequencing-based tests.For an introduction to multigene panels click here. More detailed information for clinicians ordering genetic tests can be found here.Table 1. Molecular Genetic Testing Used in Primary Hyperoxaluria Type 2View in own windowGene 1Test MethodProportion of Probands with Pathogenic Variants 2 Detectable by This MethodGRHPRSequence analysis 3>99% 4Gene-targeted deletion/duplication analysis 5Unknown 61. See Table A. Genes and Databases for chromosome locus and protein.2. See Molecular Genetics for | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. to multigene panels click here. More detailed information for clinicians ordering genetic tests can be found here.Table 1. Molecular Genetic Testing Used in Primary Hyperoxaluria Type 2View in own windowGene 1Test MethodProportion of Probands with Pathogenic Variants 2 Detectable by This MethodGRHPRSequence analysis 3>99% 4Gene-targeted deletion/duplication analysis 5Unknown 61. See Table A. Genes and Databases for chromosome locus and protein.2. See Molecular Genetics for information on allelic variants detected in this gene.3. Sequence analysis detects variants that are benign, likely benign, of uncertain significance, likely pathogenic, or pathogenic. Pathogenic variants may include small intragenic deletions/insertions and missense, nonsense, and splice site variants; typically, exon or whole-gene deletions/duplications are not detected. For issues to consider in interpretation of sequence analysis results, click here.4. Author, personal communication5. Gene-targeted | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. and protein.2. See Molecular Genetics for information on allelic variants detected in this gene.3. Sequence analysis detects variants that are benign, likely benign, of uncertain significance, likely pathogenic, or pathogenic. Pathogenic variants may include small intragenic deletions/insertions and missense, nonsense, and splice site variants; typically, exon or whole-gene deletions/duplications are not detected. For issues to consider in interpretation of sequence analysis results, click here.4. Author, personal communication5. Gene-targeted deletion/duplication analysis detects intragenic deletions or duplications. Methods used may include: quantitative PCR, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and a gene-targeted microarray designed to detect single-exon deletions or duplications.6. No data on detection rate of gene-targeted deletion/duplication analysis are available.Assay of glyoxylate reductase enzyme activityThe enzyme is primarily expressed in the liver and can be analyzed in liver | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. Author, personal communication5. Gene-targeted deletion/duplication analysis detects intragenic deletions or duplications. Methods used may include: quantitative PCR, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and a gene-targeted microarray designed to detect single-exon deletions or duplications.6. No data on detection rate of gene-targeted deletion/duplication analysis are available.Assay of glyoxylate reductase enzyme activityThe enzyme is primarily expressed in the liver and can be analyzed in liver tissue using the method described by Giafi and Rumsby . A needle biopsy (~20 mg of tissue) is required and the sample must be frozen immediately and shipped frozen to the laboratory.Note: The enzyme has also been shown to be expressed in leukocytes ; however, because of questions about the expression of the gene in leukocytes and the low activity, measurement of enzyme activity in liver biopsy rather than leukocytes is recommended for diagnosis .Clinical CharacteristicsCl | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. in the liver and can be analyzed in liver tissue using the method described by Giafi and Rumsby . A needle biopsy (~20 mg of tissue) is required and the sample must be frozen immediately and shipped frozen to the laboratory.Note: The enzyme has also been shown to be expressed in leukocytes ; however, because of questions about the expression of the gene in leukocytes and the low activity, measurement of enzyme activity in liver biopsy rather than leukocytes is recommended for diagnosis .Clinical CharacteristicsClinical DescriptionThe age of onset of primary hyperoxaluria type 2 (PH2) is typically in childhood , with those diagnosed in later life often relating symptoms from childhood . As in PH1, diagnosis is often delayed, sometimes even for years.Presenting symptoms are typically those associated with the presence of renal stones including hematuria, renal colic, or obstruction of the urinary tract . Affected individuals may also present with nephrocalcinosis or end-stage renal disease (ESRD | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. leukocytes is recommended for diagnosis .Clinical CharacteristicsClinical DescriptionThe age of onset of primary hyperoxaluria type 2 (PH2) is typically in childhood , with those diagnosed in later life often relating symptoms from childhood . As in PH1, diagnosis is often delayed, sometimes even for years.Presenting symptoms are typically those associated with the presence of renal stones including hematuria, renal colic, or obstruction of the urinary tract . Affected individuals may also present with nephrocalcinosis or end-stage renal disease (ESRD).The majority of individuals have renal stones composed of calcium oxalate .Nephrocalcinosis, observed on ultrasound examination, abdominal x-ray, or CT examination, is a much less common finding in PH2 than in PH1.The disease can progress to ESRD although this outcome appears to be later in PH2 than in PH1, in which 50% of affected individuals have ESRD by age 25 years . In a recent review of data collected through the Oxal | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. osis or end-stage renal disease (ESRD).The majority of individuals have renal stones composed of calcium oxalate .Nephrocalcinosis, observed on ultrasound examination, abdominal x-ray, or CT examination, is a much less common finding in PH2 than in PH1.The disease can progress to ESRD although this outcome appears to be later in PH2 than in PH1, in which 50% of affected individuals have ESRD by age 25 years . In a recent review of data collected through the OxalEurope Registry, of 83 individuals with PH2, 20% developed ESRD at follow up .Oxalosis. Once ESRD occurs, deposition of oxalate can occur in organs other than kidney, including bone, bone marrow, joints, retina, and myocardium along with calcified nodules on the fingers .Oxalate deposition in bone results in x-ray findings of transverse translucent symmetric bands with fixed sclerotic margins at the end of long bones followed by cystic rarefaction of | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. a recent review of data collected through the OxalEurope Registry, of 83 individuals with PH2, 20% developed ESRD at follow up .Oxalosis. Once ESRD occurs, deposition of oxalate can occur in organs other than kidney, including bone, bone marrow, joints, retina, and myocardium along with calcified nodules on the fingers .Oxalate deposition in bone results in x-ray findings of transverse translucent symmetric bands with fixed sclerotic margins at the end of long bones followed by cystic rarefaction of the bones. Osteodystrophy causes bone pain and multiple pathologic fractures occur in advanced disease. Involvement of the bone marrow can result in anemia refractory to erythropoietin-stimulating agents.Additional clinical manifestations of oxalosis may include visual disturbance due to retinopathy and/or maculopathy, cardiac conduction disturbances such as heart block, cardiomyopathy, and synovitis secondary to oxalate deposition in the joints. Vascular involvement can lead to ischemia, most often manifest as non-healing cutaneous ulcers. Dental complications | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. of long bones followed by cystic rarefaction of the bones. Osteodystrophy causes bone pain and multiple pathologic fractures occur in advanced disease. Involvement of the bone marrow can result in anemia refractory to erythropoietin-stimulating agents.Additional clinical manifestations of oxalosis may include visual disturbance due to retinopathy and/or maculopathy, cardiac conduction disturbances such as heart block, cardiomyopathy, and synovitis secondary to oxalate deposition in the joints. Vascular involvement can lead to ischemia, most often manifest as non-healing cutaneous ulcers. Dental complications include periodontal disease. Hypothyroidism is also reported.Genotype-Phenotype CorrelationsThe low prevalence of PH2 does not allow genotype-phenotype correlations at the present time.NomenclaturePrimary hyperoxaluria type 2 was originally described as:L-glyceric aciduria, referring to the excessive production of urinary L-glycerate;D-glycerate dehydrogenase deficiency, referring to the non-physiologic action of the enzyme in catalyzing the dehydrogenation of D-glycerate | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. as non-healing cutaneous ulcers. Dental complications include periodontal disease. Hypothyroidism is also reported.Genotype-Phenotype CorrelationsThe low prevalence of PH2 does not allow genotype-phenotype correlations at the present time.NomenclaturePrimary hyperoxaluria type 2 was originally described as:L-glyceric aciduria, referring to the excessive production of urinary L-glycerate;D-glycerate dehydrogenase deficiency, referring to the non-physiologic action of the enzyme in catalyzing the dehydrogenation of D-glycerate.As the more important enzyme reaction appears to be that of glyoxylate reduction, the name glyoxylate reductase is now favored.PrevalenceNo data regarding the prevalence of PH2 exist. It is thought to be less common than primary hyperoxaluria type 1, which has a prevalence of approximately 1:1,000,000. However, there may be ascertainment bias in that individuals with early signs of PH2 may be misclassified clinically as having | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. catalyzing the dehydrogenation of D-glycerate.As the more important enzyme reaction appears to be that of glyoxylate reduction, the name glyoxylate reductase is now favored.PrevalenceNo data regarding the prevalence of PH2 exist. It is thought to be less common than primary hyperoxaluria type 1, which has a prevalence of approximately 1:1,000,000. However, there may be ascertainment bias in that individuals with early signs of PH2 may be misclassified clinically as having PH1 on the grounds of severity of symptoms, and the correct diagnosis recognized only with appropriate testing.Differential DiagnosisPrimary hyperoxaluria type 1
(PH1) is the most common form of inherited hyperoxaluria, accounting for approximately 80% of cases. It is caused by a deficiency of the liver peroxisomal enzyme alanine:glyoxylate aminotransferase (AGT), which catalyzes the conversion of glyoxylate to glycine. When AGT activity is | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. PH2 may be misclassified clinically as having PH1 on the grounds of severity of symptoms, and the correct diagnosis recognized only with appropriate testing.Differential DiagnosisPrimary hyperoxaluria type 1
(PH1) is the most common form of inherited hyperoxaluria, accounting for approximately 80% of cases. It is caused by a deficiency of the liver peroxisomal enzyme alanine:glyoxylate aminotransferase (AGT), which catalyzes the conversion of glyoxylate to glycine. When AGT activity is absent, glyoxylate is converted to oxalate, which forms insoluble calcium salts that accumulate in the kidney and other organs. Individuals with PH1 are at risk for recurrent nephrolithiasis (deposition of calcium oxalate in the renal pelvis/urinary tract), nephrocalcinosis (deposition of calcium oxalate in the renal parenchyma), or ESRD with a history of renal stones or oxalosis. Although the hyperoxaluria is present from birth and most individuals present in childhood | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. ate to glycine. When AGT activity is absent, glyoxylate is converted to oxalate, which forms insoluble calcium salts that accumulate in the kidney and other organs. Individuals with PH1 are at risk for recurrent nephrolithiasis (deposition of calcium oxalate in the renal pelvis/urinary tract), nephrocalcinosis (deposition of calcium oxalate in the renal parenchyma), or ESRD with a history of renal stones or oxalosis. Although the hyperoxaluria is present from birth and most individuals present in childhood or adolescence, age at symptom onset ranges from infancy to adulthood. Approximately 15% of affected individuals present before age four to six months with severe disease including nephrocalcinosis; 55% present in childhood or early adolescence with symptomatic nephrolithiasis; and the remainder present in adulthood with recurrent renal stones. Untreated PH1 often progresses to nephrolithiasis/nephrocalcinosis, decline in renal function, systemic oxalosis (widespread tissue deposition of calcium oxalate), and | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. present from birth and most individuals present in childhood or adolescence, age at symptom onset ranges from infancy to adulthood. Approximately 15% of affected individuals present before age four to six months with severe disease including nephrocalcinosis; 55% present in childhood or early adolescence with symptomatic nephrolithiasis; and the remainder present in adulthood with recurrent renal stones. Untreated PH1 often progresses to nephrolithiasis/nephrocalcinosis, decline in renal function, systemic oxalosis (widespread tissue deposition of calcium oxalate), and death from ESRD. Diagnosis relies on: (1) either (a) detection of increased urinary oxalate excretion (or elevated oxalate:creatinine ratio) or (b) in the setting of moderate to advanced renal failure, increased plasma oxalate concentration; and (2) deficiency of AGT catalytic activity from liver biopsy or molecular genetic testing of AGXT, the only gene known to be associated with PH1. Inheritance is autosomal recessive.Primary hyperoxaluria type 3 | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. widespread tissue deposition of calcium oxalate), and death from ESRD. Diagnosis relies on: (1) either (a) detection of increased urinary oxalate excretion (or elevated oxalate:creatinine ratio) or (b) in the setting of moderate to advanced renal failure, increased plasma oxalate concentration; and (2) deficiency of AGT catalytic activity from liver biopsy or molecular genetic testing of AGXT, the only gene known to be associated with PH1. Inheritance is autosomal recessive.Primary hyperoxaluria type 3
(PH3) has a phenotype similar to that of PH1 and PH2 and accounts for approximately 10% of cases of primary hyperoxaluria . A provisional biochemical diagnosis can be made by the finding of elevated 4-hydroxy-2-oxoglutarate and dihydroxyglutarate in urine followed by confirmation with sequence analysis of HOGA1. Pathogenic variants in HOGA1 result in deficiency of mitochondrial 4-hydroxy-2-oxoglutarate aldolase, | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. autosomal recessive.Primary hyperoxaluria type 3
(PH3) has a phenotype similar to that of PH1 and PH2 and accounts for approximately 10% of cases of primary hyperoxaluria . A provisional biochemical diagnosis can be made by the finding of elevated 4-hydroxy-2-oxoglutarate and dihydroxyglutarate in urine followed by confirmation with sequence analysis of HOGA1. Pathogenic variants in HOGA1 result in deficiency of mitochondrial 4-hydroxy-2-oxoglutarate aldolase, an enzyme that catalyzes one of the steps in the metabolism of hydroxyproline. The hyperoxaluria in individuals with PH3 arises from breakdown of the substrate for the enzyme rather than excessive production of glyoxylate. Inheritance is autosomal recessive.Other hereditable causes of kidney stones. Other heritable disorders that present with early stone formation include Dent disease, renal tubular acidosis, cystinuria (OMIM 220100), xanthinuria (OMIM 278300, | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. -2-oxoglutarate aldolase, an enzyme that catalyzes one of the steps in the metabolism of hydroxyproline. The hyperoxaluria in individuals with PH3 arises from breakdown of the substrate for the enzyme rather than excessive production of glyoxylate. Inheritance is autosomal recessive.Other hereditable causes of kidney stones. Other heritable disorders that present with early stone formation include Dent disease, renal tubular acidosis, cystinuria (OMIM 220100), xanthinuria (OMIM 278300, 603592), and adenine phosphoribosyltransferase deficiency. In individuals presenting with symptoms related to renal stone disease it is essential to analyze the stone if possible as this can help to direct the clinician to a particular line of investigation. Urine should be analyzed for a stone risk profile that typically includes assessment of urine volume, oxalate, calcium, magnesium, citrate, phosphate, sodium, and urate.End-stage renal disease (ESRD). For persons presenting in | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. inuria (OMIM 278300, 603592), and adenine phosphoribosyltransferase deficiency. In individuals presenting with symptoms related to renal stone disease it is essential to analyze the stone if possible as this can help to direct the clinician to a particular line of investigation. Urine should be analyzed for a stone risk profile that typically includes assessment of urine volume, oxalate, calcium, magnesium, citrate, phosphate, sodium, and urate.End-stage renal disease (ESRD). For persons presenting in ESRD, reliable measurement of urine oxalate excretion is not possible. Plasma oxalate elevations ranging up to 40 μmol/L may be detected with any form of ESRD; plasma oxalate concentrations exceeding 50 μmol/L are suggestive of primary hyperoxaluria. While PH1 and PH2 are a rare cause of ESRD in adults, PH can account for 0.7%-1.6% of ESRD in children. In a native kidney or renal allograft biopsy, PH should | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. disease (ESRD). For persons presenting in ESRD, reliable measurement of urine oxalate excretion is not possible. Plasma oxalate elevations ranging up to 40 μmol/L may be detected with any form of ESRD; plasma oxalate concentrations exceeding 50 μmol/L are suggestive of primary hyperoxaluria. While PH1 and PH2 are a rare cause of ESRD in adults, PH can account for 0.7%-1.6% of ESRD in children. In a native kidney or renal allograft biopsy, PH should be considered if birefringent crystals are seen under polarized light. Although the measurement of plasma L-glycerate can identify individuals with PH2 who are in ESRD, such testing is not routinely available. Definitive diagnosis requires molecular genetic testing or analysis of relevant enzymes in a liver biopsy.Enteric hyperoxaluria. Disorders of the gastrointestinal tract leading to malabsorption (e.g., celiac disease, Crohn's disease, pancreatitis, short bowel syndrome) have the potential | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. native kidney or renal allograft biopsy, PH should be considered if birefringent crystals are seen under polarized light. Although the measurement of plasma L-glycerate can identify individuals with PH2 who are in ESRD, such testing is not routinely available. Definitive diagnosis requires molecular genetic testing or analysis of relevant enzymes in a liver biopsy.Enteric hyperoxaluria. Disorders of the gastrointestinal tract leading to malabsorption (e.g., celiac disease, Crohn's disease, pancreatitis, short bowel syndrome) have the potential to increase oxalate absorption and lead to hyperoxaluria; they can usually be excluded based on history. Gastric bypass procedures have been associated with increased oxalate absorption, high levels of hyperoxaluria, and increased risk of kidney stone formation . Urinary risk factors for stones such as hyperoxaluria occur more commonly in individuals with Roux-en-Y gastric bypass than gastric banding .Dietary hyperoxaluria. Excess intake of foods high in oxalate including chocolate, | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. pancreatitis, short bowel syndrome) have the potential to increase oxalate absorption and lead to hyperoxaluria; they can usually be excluded based on history. Gastric bypass procedures have been associated with increased oxalate absorption, high levels of hyperoxaluria, and increased risk of kidney stone formation . Urinary risk factors for stones such as hyperoxaluria occur more commonly in individuals with Roux-en-Y gastric bypass than gastric banding .Dietary hyperoxaluria. Excess intake of foods high in oxalate including chocolate, cocoa, leafy greens (especially rhubarb and spinach), black tea, nuts, peanut butter, or starfruit may increase urinary concentration of oxalate. Between 24% and 53% of urinary oxalate is attributable to oxalate from the diet . Therapy consists of dietary oxalate restriction and use of calcium carbonate or calcium citrate at meal times to bind dietary oxalate .Megadoses of vitamin C (4 g/day) have led to | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. high in oxalate including chocolate, cocoa, leafy greens (especially rhubarb and spinach), black tea, nuts, peanut butter, or starfruit may increase urinary concentration of oxalate. Between 24% and 53% of urinary oxalate is attributable to oxalate from the diet . Therapy consists of dietary oxalate restriction and use of calcium carbonate or calcium citrate at meal times to bind dietary oxalate .Megadoses of vitamin C (4 g/day) have led to hyperoxaluria , as has (deliberate or accidental) ingestion of ethylene glycol.ManagementEvaluations Following Initial DiagnosisTo establish the extent of disease in an individual diagnosed with primary hyperoxaluria type 2 (PH2), the following evaluations, originally outlined for PH1, are recommended if they have not already been completed :Assessment of renal functionIf moderate to advanced ESRD is present, assessment of systemic oxalate deposition in tissue and bone:Bone x-rays to | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. (4 g/day) have led to hyperoxaluria , as has (deliberate or accidental) ingestion of ethylene glycol.ManagementEvaluations Following Initial DiagnosisTo establish the extent of disease in an individual diagnosed with primary hyperoxaluria type 2 (PH2), the following evaluations, originally outlined for PH1, are recommended if they have not already been completed :Assessment of renal functionIf moderate to advanced ESRD is present, assessment of systemic oxalate deposition in tissue and bone:Bone x-rays to look for radiodense metaphyseal bands followed by cystic rarefaction of bonesOphthalmic examination of the retina to look for oxalate crystalsEvaluation of cardiac function by echocardiography and ECGConsultation with a clinical geneticist and/or genetic counselorTreatment of ManifestationsManagement follows general guidance for that of renal stones: to relieve obstruction, and to manage symptoms of renal impairment as they arise.Reduction of Calcium Oxalate SupersaturationAs with PH1, conservative | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. tissue and bone:Bone x-rays to look for radiodense metaphyseal bands followed by cystic rarefaction of bonesOphthalmic examination of the retina to look for oxalate crystalsEvaluation of cardiac function by echocardiography and ECGConsultation with a clinical geneticist and/or genetic counselorTreatment of ManifestationsManagement follows general guidance for that of renal stones: to relieve obstruction, and to manage symptoms of renal impairment as they arise.Reduction of Calcium Oxalate SupersaturationAs with PH1, conservative therapy is applied with the aim of minimizing oxalate-related renal injury and preserving renal function. Treatment of persons with preserved renal function, reviewed by Cochat et al , essentially aims to improve oxalate solubility as follows:Adequate fluid intake (>2.5 L/m2 surface area/day)Urinary inhibitors of calcium oxalate crystallization:Orthophosphate treatment (20-30 mg/kg body weight/day)Potassium citrate (0.1 | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. Oxalate SupersaturationAs with PH1, conservative therapy is applied with the aim of minimizing oxalate-related renal injury and preserving renal function. Treatment of persons with preserved renal function, reviewed by Cochat et al , essentially aims to improve oxalate solubility as follows:Adequate fluid intake (>2.5 L/m2 surface area/day)Urinary inhibitors of calcium oxalate crystallization:Orthophosphate treatment (20-30 mg/kg body weight/day)Potassium citrate (0.1-0.15 g/kg body weight/day)DialysisBecause the plasma oxalate concentration begins to rise when the renal clearance is less than 40 mL/min/1.73 m2, early initiation of dialysis or preemptive kidney-only transplantation is preferred.Oxalate clearance on hemodialysis is greater than on peritoneal dialysis (120 mls/min on hemodialysis vs 7 mls/min on peritoneal dialysis): standard hemodialysis programs will result in clearance of | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. /day)Potassium citrate (0.1-0.15 g/kg body weight/day)DialysisBecause the plasma oxalate concentration begins to rise when the renal clearance is less than 40 mL/min/1.73 m2, early initiation of dialysis or preemptive kidney-only transplantation is preferred.Oxalate clearance on hemodialysis is greater than on peritoneal dialysis (120 mls/min on hemodialysis vs 7 mls/min on peritoneal dialysis): standard hemodialysis programs will result in clearance of oxalate of 6-9 mmol/1.73 m2/week, which is equivalent to two to three days of endogenous production of oxalate. Thus a combination of modalities, with intermittent daily hemodialysis together with overnight peritoneal dialysis, or intense home hemodialysis, enhances the overall clearance of oxalate and attempts to reduce the rebound that occurs after hemodialysis. These combination therapies, with the use of high flux dialyzers or long episodes of hemofiltration, have all been advocated | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. : standard hemodialysis programs will result in clearance of oxalate of 6-9 mmol/1.73 m2/week, which is equivalent to two to three days of endogenous production of oxalate. Thus a combination of modalities, with intermittent daily hemodialysis together with overnight peritoneal dialysis, or intense home hemodialysis, enhances the overall clearance of oxalate and attempts to reduce the rebound that occurs after hemodialysis. These combination therapies, with the use of high flux dialyzers or long episodes of hemofiltration, have all been advocated to improve oxalate removal .For individuals in ESRD, intensive (daily) dialysis is required to maximize oxalate removal. As in PH1, the longer the individual with PH2 is on dialysis the more likely systemic oxalate deposition will occur.Organ TransplantationKidney transplantation alone has been used in PH2 with varying success. Careful management in the postoperative period, with attention to brisk urine output and use of calcium oxalate urinary inhibitors, minimizes the risk of allograft loss | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. of hemofiltration, have all been advocated to improve oxalate removal .For individuals in ESRD, intensive (daily) dialysis is required to maximize oxalate removal. As in PH1, the longer the individual with PH2 is on dialysis the more likely systemic oxalate deposition will occur.Organ TransplantationKidney transplantation alone has been used in PH2 with varying success. Careful management in the postoperative period, with attention to brisk urine output and use of calcium oxalate urinary inhibitors, minimizes the risk of allograft loss as a result of oxalate deposition. As it is not unusual for such transplants to fail in individuals with PH2 and as there is more enzyme present in the liver than in other tissues , combined liver-kidney transplant may have some merit.To date, there is just one published report of a successful liver-kidney transplantation in an individual with PH2 with a previously failed renal allograft . Urine glycerate and oxalate and plasma oxalate all normalized within one month post transplant | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. urinary inhibitors, minimizes the risk of allograft loss as a result of oxalate deposition. As it is not unusual for such transplants to fail in individuals with PH2 and as there is more enzyme present in the liver than in other tissues , combined liver-kidney transplant may have some merit.To date, there is just one published report of a successful liver-kidney transplantation in an individual with PH2 with a previously failed renal allograft . Urine glycerate and oxalate and plasma oxalate all normalized within one month post transplant and remained normal for the 13-month follow up.OtherPharmacologic doses of pyridoxine are used as a treatment in individuals with PH1 because of its role as a cofactor for the defective enzyme. There is no supportive evidence for the use of pyridoxine in individuals with PH2.Prevention of Primary ManifestationsThe main preventive treatment is to maintain adequate hydration status and to enhance calcium oxalate solubility with exogenous citrate and neutral phosphates as described in Treatment of Manifestations | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. plasma oxalate all normalized within one month post transplant and remained normal for the 13-month follow up.OtherPharmacologic doses of pyridoxine are used as a treatment in individuals with PH1 because of its role as a cofactor for the defective enzyme. There is no supportive evidence for the use of pyridoxine in individuals with PH2.Prevention of Primary ManifestationsThe main preventive treatment is to maintain adequate hydration status and to enhance calcium oxalate solubility with exogenous citrate and neutral phosphates as described in Treatment of Manifestations.SurveillanceFrequency of recommended screening can vary; however, as a guide, the following are recommended.Individuals with preserved renal function (i.e., measured or estimated GFR ≥60 mL/min/1.73 m2) require the following to evaluate/ensure treatment efficacy:Biannually. Assessment of renal function, urinalysis with measurements of urine oxalate excretion using 24-hour collection if easy to facilitate; or spot urine oxalate- | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. and neutral phosphates as described in Treatment of Manifestations.SurveillanceFrequency of recommended screening can vary; however, as a guide, the following are recommended.Individuals with preserved renal function (i.e., measured or estimated GFR ≥60 mL/min/1.73 m2) require the following to evaluate/ensure treatment efficacy:Biannually. Assessment of renal function, urinalysis with measurements of urine oxalate excretion using 24-hour collection if easy to facilitate; or spot urine oxalate-to-creatinine ratio, and calcium oxalate saturation if available, blood pressure, and full blood count including hematocrit. The presence of blood in the urine may indicate stones, but protein in an early morning sample necessitates review of renal function as it may herald a decline in GRF.Biannually to annually. Renal imaging (ultrasound or CT examination) to assess renal stone burden as appropriate. Note: Annual scans are appropriate if no stones or nephrocalcinosis | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. easy to facilitate; or spot urine oxalate-to-creatinine ratio, and calcium oxalate saturation if available, blood pressure, and full blood count including hematocrit. The presence of blood in the urine may indicate stones, but protein in an early morning sample necessitates review of renal function as it may herald a decline in GRF.Biannually to annually. Renal imaging (ultrasound or CT examination) to assess renal stone burden as appropriate. Note: Annual scans are appropriate if no stones or nephrocalcinosis are visualized.Individuals with a GFR <60 mL/min/1.73 m2 should have the above evaluations performed quarterly, as well as the following testing annually to evaluate for involvement of other organ systems apart from the renal tract.Bone. X-ray examination to evaluate for the development of transverse translucent symmetric bands with fixed sclerotic margins at the end of long bones, cystic rarefaction of bones, and pathologic fractures. DEXA scanning | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. are appropriate if no stones or nephrocalcinosis are visualized.Individuals with a GFR <60 mL/min/1.73 m2 should have the above evaluations performed quarterly, as well as the following testing annually to evaluate for involvement of other organ systems apart from the renal tract.Bone. X-ray examination to evaluate for the development of transverse translucent symmetric bands with fixed sclerotic margins at the end of long bones, cystic rarefaction of bones, and pathologic fractures. DEXA scanning may be considered every five years. MRI or CT scanning of bones may provide further information but are not routinely recommended at present.Hematology. Full blood count with hematocrit for anemia; a bone marrow aspirate may rarely be required to determine if oxalate crystals in the bone marrow are contributing to an erythropoietin resistant anemia.Eye. Ophthalmology examination with fundoscopy to evaluate for retinopathy and maculopathyCardiac. Electrocardiogram for cardiac conduction defects and echocardiogram to evaluate contractility if appropriateSk | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. bones, and pathologic fractures. DEXA scanning may be considered every five years. MRI or CT scanning of bones may provide further information but are not routinely recommended at present.Hematology. Full blood count with hematocrit for anemia; a bone marrow aspirate may rarely be required to determine if oxalate crystals in the bone marrow are contributing to an erythropoietin resistant anemia.Eye. Ophthalmology examination with fundoscopy to evaluate for retinopathy and maculopathyCardiac. Electrocardiogram for cardiac conduction defects and echocardiogram to evaluate contractility if appropriateSkin. Clinical examination for subungual deposits of oxalate and cutaneous ulcers as evidence of vasculopathyJoints. Clinical examination for evidence of synovitis; arthroscopy may be considered on an individual basis.Teeth. Dental examination for periodontal diseaseThyroid. Thyroid function tests including TSH and free T4 for hypothyroidismPlasma oxalate. Measure every four to six months until GFR falls below 15 mL/min/1.73 m2 when levels will be noted to rise in keeping with renal | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. defects and echocardiogram to evaluate contractility if appropriateSkin. Clinical examination for subungual deposits of oxalate and cutaneous ulcers as evidence of vasculopathyJoints. Clinical examination for evidence of synovitis; arthroscopy may be considered on an individual basis.Teeth. Dental examination for periodontal diseaseThyroid. Thyroid function tests including TSH and free T4 for hypothyroidismPlasma oxalate. Measure every four to six months until GFR falls below 15 mL/min/1.73 m2 when levels will be noted to rise in keeping with renal impairment and may become more difficult to interpret. While on dialysis, measure plasma oxalate monthly to inform changes in dialysis prescription.Agents/Circumstances to AvoidThe following should be avoided:DehydrationExcessive ascorbate (i.e. vitamin C; >1000 mg/day)Foods rich in oxalate (chocolate, rhubarb, spinach, and star fruit in particular)High salt (sodium) diet should be discouraged.Excessive stone interventions | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. will be noted to rise in keeping with renal impairment and may become more difficult to interpret. While on dialysis, measure plasma oxalate monthly to inform changes in dialysis prescription.Agents/Circumstances to AvoidThe following should be avoided:DehydrationExcessive ascorbate (i.e. vitamin C; >1000 mg/day)Foods rich in oxalate (chocolate, rhubarb, spinach, and star fruit in particular)High salt (sodium) diet should be discouraged.Excessive stone interventions with extracorporal shock wave lithotripsyEvaluation of Relatives at RiskIn order to delay disease onset in asymptomatic relatives, it is prudent to evaluate at-risk family members before symptoms occur. Evaluations can include:Molecular genetic testing if the pathogenic variants in the family are known;Measurement of urinary oxalate excretion if the pathogenic variants in the family are not known.Molecular genetic testing tends to be more reliable as urine oxalate output can be variable in childhood.See | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. diet should be discouraged.Excessive stone interventions with extracorporal shock wave lithotripsyEvaluation of Relatives at RiskIn order to delay disease onset in asymptomatic relatives, it is prudent to evaluate at-risk family members before symptoms occur. Evaluations can include:Molecular genetic testing if the pathogenic variants in the family are known;Measurement of urinary oxalate excretion if the pathogenic variants in the family are not known.Molecular genetic testing tends to be more reliable as urine oxalate output can be variable in childhood.See Genetic Counseling for issues related to testing of at-risk relatives for genetic counseling purposes.Pregnancy ManagementFor pregnant women with PH2, close monitoring by both an obstetrician and nephrologist is indicated because of the increased risk of decline in renal function together with developing nephrolithiasis during pregnancy or after delivery.See MotherToBaby for further information on medication use during pregnancy.Therapies Under InvestigationOxalobacter formigenes treatment did not demonstrate significant effect in reducing oxalate via | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. oxalate output can be variable in childhood.See Genetic Counseling for issues related to testing of at-risk relatives for genetic counseling purposes.Pregnancy ManagementFor pregnant women with PH2, close monitoring by both an obstetrician and nephrologist is indicated because of the increased risk of decline in renal function together with developing nephrolithiasis during pregnancy or after delivery.See MotherToBaby for further information on medication use during pregnancy.Therapies Under InvestigationOxalobacter formigenes treatment did not demonstrate significant effect in reducing oxalate via gut excretion in individuals with PH1 but continues to undergo clinical trials in individuals with hyperoxaluria and impaired renal function .Other proposed trials include the use of inhibitors of glycolate oxidase (ALN-GO1) to reduce the amount of glyoxylate produced, although this treatment would be mainly relevant to treatment of individuals with PH1.Search ClinicalTrials.gov in the US and www.ClinicalTrialsRegister.eu in Europe for access to information on clinical | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK2692/ | rnyMyR0 | Primary Hyperoxaluria Type 2 | C0268165 | 16 | primary hyperoxaluria type 2. did not demonstrate significant effect in reducing oxalate via gut excretion in individuals with PH1 but continues to undergo clinical trials in individuals with hyperoxaluria and impaired renal function .Other proposed trials include the use of inhibitors of glycolate oxidase (ALN-GO1) to reduce the amount of glyoxylate produced, although this treatment would be mainly relevant to treatment of individuals with PH1.Search ClinicalTrials.gov in the US and www.ClinicalTrialsRegister.eu in Europe for access to information on clinical studies for a wide range of diseases and conditions. | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. SummaryClinical characteristics.Primary congenital glaucoma (PCG) is characterized by elevated intraocular pressure (IOP), enlargement of the globe (buphthalmos), edema, and opacification of the cornea with rupture of Descemet's membrane (Haab’s striae), thinning of the anterior sclera and iris atrophy, anomalously deep anterior chamber, and structurally normal posterior segment except for progressive glaucomatous optic atrophy. Symptoms include photophobia, blepharospasm, and excessive tearing. Typically, the diagnosis is made in the first year of life. Depending on when treatment is instituted, visual acuity may be reduced and/or visual fields may be restricted. In untreated individuals, blindness invariably occurs.Diagnosis/testing.The diagnosis of PCG is based on clinical criteria including: elevated IOP in a child typically before age one year, enlargement of the globe, increased corneal diameter, cloudy corneas, breaks in Decsemet’s membrane ( | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. pharospasm, and excessive tearing. Typically, the diagnosis is made in the first year of life. Depending on when treatment is instituted, visual acuity may be reduced and/or visual fields may be restricted. In untreated individuals, blindness invariably occurs.Diagnosis/testing.The diagnosis of PCG is based on clinical criteria including: elevated IOP in a child typically before age one year, enlargement of the globe, increased corneal diameter, cloudy corneas, breaks in Decsemet’s membrane (Haab’s striae) and anomalously deep anterior chamber. Identification of biallelic pathogenic variants in CYP1B1 or LTBP2 or identification of a heterozygous pathogenic variant in TEK confirms the diagnosis if clinical features are inconclusive.Management.Treatment of manifestations: Surgery (goniotomy, trabeculotomy, trabeculectomy, or deep sclerectomy) as early as possible; use of drainage implants or cyclodestruction if surgery fails; medication preoperatively | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. semet’s membrane (Haab’s striae) and anomalously deep anterior chamber. Identification of biallelic pathogenic variants in CYP1B1 or LTBP2 or identification of a heterozygous pathogenic variant in TEK confirms the diagnosis if clinical features are inconclusive.Management.Treatment of manifestations: Surgery (goniotomy, trabeculotomy, trabeculectomy, or deep sclerectomy) as early as possible; use of drainage implants or cyclodestruction if surgery fails; medication preoperatively and postoperatively to help control IOP; routine treatment of refractive errors and amblyopia.Prevention of secondary complications: Discontinuation of medications such as Phospholine Iodide® (echothiophate) before surgery to prevent prolonged apnea.Surveillance: Lifelong monitoring to ensure control of IOP.Agents/circumstances to avoid: Alpha-2 agonists because of risk for apnea and bradycardia.Evaluation of relatives
at risk: If the pathogenic variant(s) have been identified in the family, molecular genetic testing of | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. if surgery fails; medication preoperatively and postoperatively to help control IOP; routine treatment of refractive errors and amblyopia.Prevention of secondary complications: Discontinuation of medications such as Phospholine Iodide® (echothiophate) before surgery to prevent prolonged apnea.Surveillance: Lifelong monitoring to ensure control of IOP.Agents/circumstances to avoid: Alpha-2 agonists because of risk for apnea and bradycardia.Evaluation of relatives
at risk: If the pathogenic variant(s) have been identified in the family, molecular genetic testing of at-risk sibs as soon as possible after birth in order to avoid repeated examinations under anesthesia in young children who do not have the pathogenic variant(s).Genetic counseling.PCG caused by biallelic pathogenic variants in CYP1B1 or LTBP2 is inherited in an autosomal recessive manner. PCG caused by a heterozygous pathogenic variant in TEK is inherited in an autosomal dominant manner.Autosomal recessive inheritance: At conception, each sib of an affected individual has | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. family, molecular genetic testing of at-risk sibs as soon as possible after birth in order to avoid repeated examinations under anesthesia in young children who do not have the pathogenic variant(s).Genetic counseling.PCG caused by biallelic pathogenic variants in CYP1B1 or LTBP2 is inherited in an autosomal recessive manner. PCG caused by a heterozygous pathogenic variant in TEK is inherited in an autosomal dominant manner.Autosomal recessive inheritance: At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Heterozygotes (carriers) are asymptomatic; carrier testing for at-risk family members is possible if the pathogenic variants in the family are known.Autosomal dominant inheritance: Each child of an individual with TEK-related PCG has a 50% chance of inheriting the pathogenic variant.Prenatal diagnosis for pregnancies at increased risk is | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Heterozygotes (carriers) are asymptomatic; carrier testing for at-risk family members is possible if the pathogenic variants in the family are known.Autosomal dominant inheritance: Each child of an individual with TEK-related PCG has a 50% chance of inheriting the pathogenic variant.Prenatal diagnosis for pregnancies at increased risk is possible if the PCG-causing pathogenic variant(s) in the family are known.DiagnosisSuggestive FindingsPrimary congenital glaucoma (PCG) should be suspected in infants or children with the following clinical features:Photophobia, blepharospasm, and excessive tearingEdema and opacification of the cornea with rupture of Descemet's membrane, known as Haab's striaeThinning of the anterior sclera and atrophy of | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. for pregnancies at increased risk is possible if the PCG-causing pathogenic variant(s) in the family are known.DiagnosisSuggestive FindingsPrimary congenital glaucoma (PCG) should be suspected in infants or children with the following clinical features:Photophobia, blepharospasm, and excessive tearingEdema and opacification of the cornea with rupture of Descemet's membrane, known as Haab's striaeThinning of the anterior sclera and atrophy of the irisStructurally normal posterior segment except for progressive optic atrophyAbsence of structural changes in the anterior chamber that are consistent with a diagnosis of anterior segment dysgenesis or associated systemic disease.Establishing the DiagnosisThe diagnosis of PCG is established in a proband by the following clinical criteria:Elevated intraocular pressure (IOP) in an infant or child typically (but not always) before age one year. An IOP greater than 21 mm Hg (mercury) in one or both | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. anterior sclera and atrophy of the irisStructurally normal posterior segment except for progressive optic atrophyAbsence of structural changes in the anterior chamber that are consistent with a diagnosis of anterior segment dysgenesis or associated systemic disease.Establishing the DiagnosisThe diagnosis of PCG is established in a proband by the following clinical criteria:Elevated intraocular pressure (IOP) in an infant or child typically (but not always) before age one year. An IOP greater than 21 mm Hg (mercury) in one or both eyes as measured by applanation tonometry, I-care tonometry™, or pneumotonometry on at least two occasions is considered abnormally elevated. In general, normal intraocular pressure in children is 12.02 ± 3.74 mm Hg .Enlargement of the (infantile) globe (buphthalmos)Increased corneal diameter and cloudy corneasBreaks in Decsemet’s membrane (Haab’s striae)Anomalously deep anterior chamberBil | [
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] |
gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. mercury) in one or both eyes as measured by applanation tonometry, I-care tonometry™, or pneumotonometry on at least two occasions is considered abnormally elevated. In general, normal intraocular pressure in children is 12.02 ± 3.74 mm Hg .Enlargement of the (infantile) globe (buphthalmos)Increased corneal diameter and cloudy corneasBreaks in Decsemet’s membrane (Haab’s striae)Anomalously deep anterior chamberBilateral or unilateral findingsIdentification of biallelic pathogenic variants in CYP1B1 or LTBP2 or a heterozygous TEK pathogenic variant on molecular genetic testing (see Table 1) confirms the diagnosis if clinical features are inconclusive.Molecular testing approaches can include serial single-gene testing, use of a multigene panel, and more comprehensive
genomic testing:Serial single-gene testing. Perform sequence analysis of CYP1B1, followed by deletion/duplication analysis if only one or no | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. Anomalously deep anterior chamberBilateral or unilateral findingsIdentification of biallelic pathogenic variants in CYP1B1 or LTBP2 or a heterozygous TEK pathogenic variant on molecular genetic testing (see Table 1) confirms the diagnosis if clinical features are inconclusive.Molecular testing approaches can include serial single-gene testing, use of a multigene panel, and more comprehensive
genomic testing:Serial single-gene testing. Perform sequence analysis of CYP1B1, followed by deletion/duplication analysis if only one or no pathogenic variant is found. If no CYP1B1 pathogenic variants are identified, consider sequence analysis of LTBP2. Sequence analysis and gene-targeted deletion/duplication analysis of TEK can be considered next if one or no pathogenic has been identified.Targeted analysis for CYP1B1 pathogenic variant p.Glu387Lys may be performed first in individuals of Rom Slovakian ancestry.CYP1B1 pathogenic variant p.Gly61Glu may be performed first in individuals | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. analysis if only one or no pathogenic variant is found. If no CYP1B1 pathogenic variants are identified, consider sequence analysis of LTBP2. Sequence analysis and gene-targeted deletion/duplication analysis of TEK can be considered next if one or no pathogenic has been identified.Targeted analysis for CYP1B1 pathogenic variant p.Glu387Lys may be performed first in individuals of Rom Slovakian ancestry.CYP1B1 pathogenic variant p.Gly61Glu may be performed first in individuals of Saudi Arabian ancestry.A multigene panel that includes CYP1B1, LTBP2, TEK, and other genes of interest (see Differential Diagnosis) may also be considered. Note: (1) The genes included in the panel and the diagnostic sensitivity of the testing used for each gene vary by laboratory and are likely to change over time. (2) Some multigene panels may include genes not associated with the condition discussed in this GeneReview; | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. may be performed first in individuals of Saudi Arabian ancestry.A multigene panel that includes CYP1B1, LTBP2, TEK, and other genes of interest (see Differential Diagnosis) may also be considered. Note: (1) The genes included in the panel and the diagnostic sensitivity of the testing used for each gene vary by laboratory and are likely to change over time. (2) Some multigene panels may include genes not associated with the condition discussed in this GeneReview; thus, clinicians need to determine which multigene panel is most likely to identify the genetic cause of the condition at the most reasonable cost while limiting identification of variants of uncertain significance and pathogenic variants in genes that do not explain the underlying phenotype. (3) In some laboratories, panel options may include a custom laboratory-designed panel and/or custom phenotype-focused exome analysis that includes genes specified by the clinician. (4) Methods used in a panel may include sequence analysis, | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. this GeneReview; thus, clinicians need to determine which multigene panel is most likely to identify the genetic cause of the condition at the most reasonable cost while limiting identification of variants of uncertain significance and pathogenic variants in genes that do not explain the underlying phenotype. (3) In some laboratories, panel options may include a custom laboratory-designed panel and/or custom phenotype-focused exome analysis that includes genes specified by the clinician. (4) Methods used in a panel may include sequence analysis, deletion/duplication analysis, and/or other non-sequencing-based tests.For an introduction to multigene panels click here. More detailed information for clinicians ordering genetic tests can be found here.More comprehensive genomic testing (when available) including exome sequencing and genome sequencing may be considered. Such testing may provide or suggest a diagnosis not previously considered (e.g., mutation of a different gene or genes that results in a similar clinical presentation).For an introduction to | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. panel may include sequence analysis, deletion/duplication analysis, and/or other non-sequencing-based tests.For an introduction to multigene panels click here. More detailed information for clinicians ordering genetic tests can be found here.More comprehensive genomic testing (when available) including exome sequencing and genome sequencing may be considered. Such testing may provide or suggest a diagnosis not previously considered (e.g., mutation of a different gene or genes that results in a similar clinical presentation).For an introduction to comprehensive genomic testing click here. More detailed information for clinicians ordering genomic testing can be found here.Table 1. Molecular Genetic Testing Used in Primary Congenital GlaucomaView in own windowGene 1Proportion of PGC Attributed to Pathogenic Variants in GeneProportion of Pathogenic Variants 2 Detectable by MethodSequence analysis 3Gene-targeted deletion/duplication analysis 4CYP1B120%-100% of familial cases 510%-15% of simplex cases 6~ 90%-95%~5 | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. ).For an introduction to comprehensive genomic testing click here. More detailed information for clinicians ordering genomic testing can be found here.Table 1. Molecular Genetic Testing Used in Primary Congenital GlaucomaView in own windowGene 1Proportion of PGC Attributed to Pathogenic Variants in GeneProportion of Pathogenic Variants 2 Detectable by MethodSequence analysis 3Gene-targeted deletion/duplication analysis 4CYP1B120%-100% of familial cases 510%-15% of simplex cases 6~ 90%-95%~5%-10% 7LTBP2≤40% 8~100%Unknown 9TEK10 families 109/10 families1 familyUnknown 11, 12NA1. See Table A. Genes and Databases for chromosome locus and protein.2. See Molecular Genetics for information on allelic variants detected in this gene.3. Sequence analysis detects variants that are benign, likely benign, of uncertain significance, likely pathogenic, or pathogenic. Pathogenic variants may include small intrag | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. %-95%~5%-10% 7LTBP2≤40% 8~100%Unknown 9TEK10 families 109/10 families1 familyUnknown 11, 12NA1. See Table A. Genes and Databases for chromosome locus and protein.2. See Molecular Genetics for information on allelic variants detected in this gene.3. Sequence analysis detects variants that are benign, likely benign, of uncertain significance, likely pathogenic, or pathogenic. Pathogenic variants may include small intragenic deletions/insertions and missense, nonsense, and splice site variants; typically, exon or whole-gene deletions/duplications are not detected. For issues to consider in interpretation of sequence analysis results, click here.4. Gene-targeted deletion/duplication analysis detects intragenic deletions or duplications. Methods used may include quantitative PCR, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and a gene-targeted microarray designed to detect single-exon deletions | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. Pathogenic variants may include small intragenic deletions/insertions and missense, nonsense, and splice site variants; typically, exon or whole-gene deletions/duplications are not detected. For issues to consider in interpretation of sequence analysis results, click here.4. Gene-targeted deletion/duplication analysis detects intragenic deletions or duplications. Methods used may include quantitative PCR, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and a gene-targeted microarray designed to detect single-exon deletions or duplications.5. The probability of identifying pathogenic variants in CYP1B1 increases with the presence of: positive family history, parental consanguinity, and bilateral and severe disease. Differences in the number of individuals studied, the methods of ascertainment (familial vs. simplex cases, unilateral vs. bilateral disease), and the molecular genetic testing methods used make accurate estimates of variant detection frequency difficult.6. Mashima et al , Stoilov et al , Curry | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. to detect single-exon deletions or duplications.5. The probability of identifying pathogenic variants in CYP1B1 increases with the presence of: positive family history, parental consanguinity, and bilateral and severe disease. Differences in the number of individuals studied, the methods of ascertainment (familial vs. simplex cases, unilateral vs. bilateral disease), and the molecular genetic testing methods used make accurate estimates of variant detection frequency difficult.6. Mashima et al , Stoilov et al , Curry et al 7. At least five CYP1B1 alleles with gross deletions, sometimes including the entire CYP1B1 along with adjacent genes, have been reported. Additionally, gross duplications and a complex mutational event are known. For details see Molecular Genetics, Table A, Locus-Specific Databases and HGMD.8. Ali et al , Narooie-Nejad et al , Micheal et al 9. No data on detection rate of gene-targeted deletion/duplication | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. ov et al , Curry et al 7. At least five CYP1B1 alleles with gross deletions, sometimes including the entire CYP1B1 along with adjacent genes, have been reported. Additionally, gross duplications and a complex mutational event are known. For details see Molecular Genetics, Table A, Locus-Specific Databases and HGMD.8. Ali et al , Narooie-Nejad et al , Micheal et al 9. No data on detection rate of gene-targeted deletion/duplication analysis are available.10. Heterozygous TEK pathogenic variants were identified in affected individuals from 10/189 unrelated families with PCG .11. Kaur et al presented evidence in a single individual that the combination of a heterozygous pathogenic variant in MYOC and a heterozygous pathogenic variant in CYP1B1 was associated with PCG, suggesting digenic inheritance. A report of a Chinese family segregating both primary congenital open-angle glaucoma (POAG) and PCG suggested that homozygous MYO | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. gene-targeted deletion/duplication analysis are available.10. Heterozygous TEK pathogenic variants were identified in affected individuals from 10/189 unrelated families with PCG .11. Kaur et al presented evidence in a single individual that the combination of a heterozygous pathogenic variant in MYOC and a heterozygous pathogenic variant in CYP1B1 was associated with PCG, suggesting digenic inheritance. A report of a Chinese family segregating both primary congenital open-angle glaucoma (POAG) and PCG suggested that homozygous MYOC variants may cause PCG .12. Two additional loci, GLC3B on 1p36 and GLC3C on 14q24.3 , have been linked to PCG; however, the genes at these loci are not known. One additional locus linked to PCG, on 14q24.2-q24.3, does not appear to overlap the GLC3C critical region .Clinical CharacteristicsClinical DescriptionPrimary congenital glaucoma (PCG) is characterized by | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. PCG suggested that homozygous MYOC variants may cause PCG .12. Two additional loci, GLC3B on 1p36 and GLC3C on 14q24.3 , have been linked to PCG; however, the genes at these loci are not known. One additional locus linked to PCG, on 14q24.2-q24.3, does not appear to overlap the GLC3C critical region .Clinical CharacteristicsClinical DescriptionPrimary congenital glaucoma (PCG) is characterized by developmental defect(s) of the trabecular meshwork and anterior chamber angle that prevent adequate drainage of aqueous humor, resulting in elevated intraocular pressure (IOP) and stretching of the sclera that produces an enlarged globe (buphthalmos).The following information comes from the detailed clinical papers on PCG of deLuise & Anderson and Ho & Walton unless otherwise noted.By definition, congenital glaucoma is present at birth; it is typically | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. PCG) is characterized by developmental defect(s) of the trabecular meshwork and anterior chamber angle that prevent adequate drainage of aqueous humor, resulting in elevated intraocular pressure (IOP) and stretching of the sclera that produces an enlarged globe (buphthalmos).The following information comes from the detailed clinical papers on PCG of deLuise & Anderson and Ho & Walton unless otherwise noted.By definition, congenital glaucoma is present at birth; it is typically diagnosed in the first year of life. PCG is more common in males (65%) and is bilateral in 70% of individuals.The clinical signs and symptoms depend primarily on the age of onset and the severity of the disease. The classic symptoms include tearing, photophobia, and irritability. Occasionally, parents may notice cloudy and/or unusually large corneas in their child caused by corneal edema; the corneal enlargement generally occurs before age three years.The most | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. at birth; it is typically diagnosed in the first year of life. PCG is more common in males (65%) and is bilateral in 70% of individuals.The clinical signs and symptoms depend primarily on the age of onset and the severity of the disease. The classic symptoms include tearing, photophobia, and irritability. Occasionally, parents may notice cloudy and/or unusually large corneas in their child caused by corneal edema; the corneal enlargement generally occurs before age three years.The most severe clinical features are typically seen in the newborn, who may present with corneal opacity, increased corneal diameter, increased IOP, and an enlarged globe . In 35 newborns with PCG, corneal edema was present in 100% of the eyes, either as diffuse (90%) or localized (10%) opacity .Early detection and appropriate treatment of congenital glaucoma can improve visual outcome. In contrast to the permanent optic nerve cupping and visual field loss seen in adults with adult- | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. age three years.The most severe clinical features are typically seen in the newborn, who may present with corneal opacity, increased corneal diameter, increased IOP, and an enlarged globe . In 35 newborns with PCG, corneal edema was present in 100% of the eyes, either as diffuse (90%) or localized (10%) opacity .Early detection and appropriate treatment of congenital glaucoma can improve visual outcome. In contrast to the permanent optic nerve cupping and visual field loss seen in adults with adult-onset glaucoma, the pressure-induced optic nerve cupping in infants and young children with PCG is reversible, particularly in the early stages of the disease. This favorable outcome is believed to be a result of the highly elastic nature of the tissues of the optic nerves of infants and young children . A delay in treatment can result in reduced visual acuity and/or restricted visual fields. In untreated individuals, blindness invariably occurs.The ultimate visual outcome depends on the severity of the disease | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. seen in adults with adult-onset glaucoma, the pressure-induced optic nerve cupping in infants and young children with PCG is reversible, particularly in the early stages of the disease. This favorable outcome is believed to be a result of the highly elastic nature of the tissues of the optic nerves of infants and young children . A delay in treatment can result in reduced visual acuity and/or restricted visual fields. In untreated individuals, blindness invariably occurs.The ultimate visual outcome depends on the severity of the disease at diagnosis, the presence of other associated ocular abnormalities, response to surgical treatment, and success in controlling IOP on follow up. The earlier the onset of clinical manifestations of glaucoma, the worse the prognosis.Despite early treatment and multiple surgical interventions, some individuals with severe disease evident at birth develop significant visual impairment from corneal opacification, advanced glaucomatous damage, or amblyopia, and may eventually become legally blind.Individuals with milder forms of disease who present later in childhood often do well with | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. on the severity of the disease at diagnosis, the presence of other associated ocular abnormalities, response to surgical treatment, and success in controlling IOP on follow up. The earlier the onset of clinical manifestations of glaucoma, the worse the prognosis.Despite early treatment and multiple surgical interventions, some individuals with severe disease evident at birth develop significant visual impairment from corneal opacification, advanced glaucomatous damage, or amblyopia, and may eventually become legally blind.Individuals with milder forms of disease who present later in childhood often do well with a single surgical procedure and have an excellent visual prognosis later in life.The IOP is a significant prognostic factor for postoperative visual function, with substantially better vision observed in individuals with IOP <19 mm Hg.Phenotype Correlations by GeneCYP1B1. Individuals with CYP1B1 pathogenic variants needed significantly more surgical procedures to control intraocular pressure than individuals with congenital glaucoma of unknown cause, when both eyes of an individual were evaluated (P=0.003) or the worst eye | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. in childhood often do well with a single surgical procedure and have an excellent visual prognosis later in life.The IOP is a significant prognostic factor for postoperative visual function, with substantially better vision observed in individuals with IOP <19 mm Hg.Phenotype Correlations by GeneCYP1B1. Individuals with CYP1B1 pathogenic variants needed significantly more surgical procedures to control intraocular pressure than individuals with congenital glaucoma of unknown cause, when both eyes of an individual were evaluated (P=0.003) or the worst eye was evaluated (P=0.011) . The correlations with genotype have been inconsistent.Individuals with CYP1B1 pathogenic variants tend to have a higher operative success rate than individuals without identified CYP1B1 pathogenic variants in terms of better intraocular pressure control effect. Together, the presence or absence of pathogenic variants in CYP1B1 and the preoperative corneal opacity score can partially predict the outcome of PCG surgery .Individuals with CYP1B1 pathogenic variants had higher last postoperative visit indices in | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. 003) or the worst eye was evaluated (P=0.011) . The correlations with genotype have been inconsistent.Individuals with CYP1B1 pathogenic variants tend to have a higher operative success rate than individuals without identified CYP1B1 pathogenic variants in terms of better intraocular pressure control effect. Together, the presence or absence of pathogenic variants in CYP1B1 and the preoperative corneal opacity score can partially predict the outcome of PCG surgery .Individuals with CYP1B1 pathogenic variants had higher last postoperative visit indices in terms of postoperative haze and the need for anti-glaucoma medications than individuals without pathogenic variants in CYP1B1 .LTBP2. Individuals with LTBP2-related PCG had clinical features not seen in individuals with pathogenic variants in CYP1B1 or TEK; these features included ectopia lentis, high arched palate, and mild-to-moderate osteopenia .TEK. Individuals with TEK-related congenital glaucoma exhibit a clinical phenotype that is variable in | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. higher last postoperative visit indices in terms of postoperative haze and the need for anti-glaucoma medications than individuals without pathogenic variants in CYP1B1 .LTBP2. Individuals with LTBP2-related PCG had clinical features not seen in individuals with pathogenic variants in CYP1B1 or TEK; these features included ectopia lentis, high arched palate, and mild-to-moderate osteopenia .TEK. Individuals with TEK-related congenital glaucoma exhibit a clinical phenotype that is variable in severity and age of onset .Genotype-Phenotype CorrelationsWalton and colleagues have shown that the phenotype can vary significantly in the same individual (one eye being more severely affected than the other) .CYP1B1. No consistent genotype-phenotype correlation has been observed for CYP1B1 pathogenic variants. Intra- and interfamilial variability is reported among individuals with identical CYP1B1 pathogenic variants . No information is available on correlation between the CYP1B1 pathogenic variants and the success | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. clinical phenotype that is variable in severity and age of onset .Genotype-Phenotype CorrelationsWalton and colleagues have shown that the phenotype can vary significantly in the same individual (one eye being more severely affected than the other) .CYP1B1. No consistent genotype-phenotype correlation has been observed for CYP1B1 pathogenic variants. Intra- and interfamilial variability is reported among individuals with identical CYP1B1 pathogenic variants . No information is available on correlation between the CYP1B1 pathogenic variants and the success of surgical therapy.LTBP2. No genotype-phenotype correlation has been observed for LTBP2 pathogenic variants.TEK. No genotype-phenotype correlation has been observed for TEK pathogenic variants.PrevalenceCYP1B1. The prevalence of CYP1B1 pathogenic variants in individuals with PCG varies: 20% in Japanese , 33.3% in Indonesians , 44% among Indians , 50% among Brazilians , 70% in Iranians , and 80%- | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. 1 pathogenic variants and the success of surgical therapy.LTBP2. No genotype-phenotype correlation has been observed for LTBP2 pathogenic variants.TEK. No genotype-phenotype correlation has been observed for TEK pathogenic variants.PrevalenceCYP1B1. The prevalence of CYP1B1 pathogenic variants in individuals with PCG varies: 20% in Japanese , 33.3% in Indonesians , 44% among Indians , 50% among Brazilians , 70% in Iranians , and 80%-100% among Saudi Arabians and the Rom Slovakian population . The relatively higher prevalence of these pathogenic variants in the latter two populations could be attributed to consanguinity.Some pathogenic variants are more common in specific ethnic groups. For example:p.Glu387Lys accounts for all the pathogenic variants in the Rom Slovakian population.p.Gly61Glu accounts for 72% of the pathogenic variants in Saudi Arabians .Additional pathogenic variants have been | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. s , and 80%-100% among Saudi Arabians and the Rom Slovakian population . The relatively higher prevalence of these pathogenic variants in the latter two populations could be attributed to consanguinity.Some pathogenic variants are more common in specific ethnic groups. For example:p.Glu387Lys accounts for all the pathogenic variants in the Rom Slovakian population.p.Gly61Glu accounts for 72% of the pathogenic variants in Saudi Arabians .Additional pathogenic variants have been associated (although with lesser frequencies) with other specific ethnic groups .PCG occurs in all ethnic groups. The birth prevalence, however, varies worldwide:1:5,000-22,000 in western countries1:2,500 in the Middle East1:1,250 in the Rom population of Slovakia 1:3,300 in the Indian state of Andhra Pradesh, where the disease accounts for approximately 4.2% of all | [
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gene_reviews | https://www.ncbi.nlm.nih.gov/books/NBK1135/ | vMOr8p4 | Primary Congenital Glaucoma | C1533041 | 17 | primary congenital glaucoma. .Additional pathogenic variants have been associated (although with lesser frequencies) with other specific ethnic groups .PCG occurs in all ethnic groups. The birth prevalence, however, varies worldwide:1:5,000-22,000 in western countries1:2,500 in the Middle East1:1,250 in the Rom population of Slovakia 1:3,300 in the Indian state of Andhra Pradesh, where the disease accounts for approximately 4.2% of all childhood blindness In Saudi Arabia and in the Rom population of Slovakia, PCG is the most common cause of childhood blindness .Differential DiagnosisA number of congenital ocular conditions can mimic PCG and must be considered by the clinician . For example, the nonspecific findings of tearing and redness of the eyes may mimic more common conditions such as conjunctivitis or congenital nasolacrimal duct obstruction; ocular irritation with photophobia and redness may mimic the more frequent problem | [
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