肾脏和泌尿系统先天性异常

Anfal Hussain Mahmoud, Iman M. Talaat, Abdelaziz Tlili, R. Hamoudi
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摘要

先天性肾脏和泌尿道异常(CAKUT)是指影响肾脏和泌尿道的一系列疾病。这些异常可能很严重,如肾脏发育不全,也可能较轻,如膀胱输尿管反流。在活产婴儿中,CAKUT 的发病率超过 1%,占儿童慢性肾衰竭病例的 40-50%。CAKUT 的发病机制是由各种环境、遗传和表观遗传因素引起的,这些因素破坏了正常的肾脏生成过程。可导致 CAKUT 的环境因素包括母体糖尿病、肥胖、营养不良、饮酒或影响肾脏发育的药物。遗传因素可导致肾小球和输尿管芽相互作用失衡。PAX2、TBX18、NRIP1、REX、SIX2、BMP4 和 17 号染色体等特定基因的缺陷会导致 CAKUT。目前已确定有 50 多个基因是导致这种病症的根本原因,单基因变异导致的病例占所有病例的 20%。CAKUT 可通过胎儿超声波检查确诊,但有些异常可能仍未被发现。全球基因组分析、下一代测序的靶向和全外显子DNA测序可提供更多的诊断方法。本综述文章重点介绍了导致 CAKUT 的一些主要因素,这些因素会对肾脏发育和泌尿道功能产生不利影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Congenital anomalies of the kidney and urinary tract
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) refer to a range of conditions that affect the kidney and urinary tract. These anomalies can be severe, such as kidney agenesis, or milder, such as vesicoureteral reflux. CAKUT affects over 1% of live births and accounts for 40–50% of cases of chronic kidney failure in children. The pathogenesis of CAKUT is caused by various environmental, genetic, and epigenetic factors that disrupt normal nephrogenesis. Environmental factors that can lead to CAKUT include maternal diabetes, obesity, malnutrition, alcohol consumption, or medications affecting kidneys development. Genetic factors can cause an imbalance in the metanephros and the ureteric bud interaction. Defects in specific genes such as PAX2, TBX18, NRIP1, REX, SIX2, BMP4, and chromosome 17 cause CAKUT. Over 50 genes have been identified as the root cause of this condition, with monogenetic variants causing up to 20% of all cases. CAKUTs can be diagnosed through fetal ultrasonography, but some anomalies may remain undetected. GWASs, Next Generation Sequencing for targeted and whole exome DNA sequencing may provide additional diagnostic methods. This review article highlights some the leading factors that cause CAKUT, which adversely affects kidney development and urinary tract function.
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