Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) account for 40-50% of pediatric end-stage kidney failure worldwide. CAKUT can occur as familial or sporadic disease with highly variable phenotypic expression. For the past 40 years, the diagnostic approach to CAKUT has relied on description of anatomic defects, which poorly discriminates subtypes of disease and provides little prognostic information. Due to paucity of fundamental insight about primary pathogenesis, therapeutic options are also severely limited. We showed that almost 20% of patients with renal hypodysplasia/agenesis carry a diagnosis of a known or novel genomic disorder, with important implications in diagnosis, genetic counseling and stratification of risk for developing severe extra-renal manifestations, such as autism, mental retardation, and others. Here, we propose to extend our study to 600 CAKUT patients for the identification of pathogenic sub- microscopic structural variants and to validate our results in 400 patients already genotyped in the lab, and replicate results in 1,000 patients genotyped by collaborators and the Children's Hospital of Philadelphia (CHOP). Moreover, we will proceed to identify smaller, potentially pathogenic single-gene CNVs and we will follow up the results by screening for independent point mutations in familial and sporadic patients to identify novel CAKUT-specific genes. We will share data promptly with the research community to aid progress in the field.

Public Health Relevance

This project aims to perform a rapid genetic diagnosis in patients with congenital anomalies of the kidney and urinary tract via genome-wide search of rare copy number variations. Moreover, this approach will identify a catalogue of novel genomic disorders and novel candidate genes. This study will have significant implications in diagnosis, genetic counseling, and risk stratification for associated phenotype that develop later in life, such as autism, schizophrenia, cognitive impairment, and others. All data will be promptly released to the research community in order to facilitate progress in the field.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-DKUS-L (81))
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Rasooly, Rebekah S
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Columbia University
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Sanna-Cherchi, Simone; Westland, Rik; Ghiggeri, Gian Marco et al. (2018) Genetic basis of human congenital anomalies of the kidney and urinary tract. J Clin Invest 128:4-15
Lopez-Rivera, Esther; Liu, Yangfan P; Verbitsky, Miguel et al. (2017) Genetic Drivers of Kidney Defects in the DiGeorge Syndrome. N Engl J Med 376:742-754
Westland, Rik; Verbitsky, Miguel; Vukojevic, Katarina et al. (2015) Copy number variation analysis identifies novel CAKUT candidate genes in children with a solitary functioning kidney. Kidney Int 88:1402-1410
Verbitsky, Miguel; Sanna-Cherchi, Simone; Fasel, David A et al. (2015) Genomic imbalances in pediatric patients with chronic kidney disease. J Clin Invest 125:2171-8
Westland, Rik; Sanna-Cherchi, Simone (2014) Recessive mutations in CAKUT and VACTERL association. Kidney Int 85:1253-5
Westland, Rik; Schreuder, Michiel F; van Goudoever, Johannes B et al. (2014) Clinical implications of the solitary functioning kidney. Clin J Am Soc Nephrol 9:978-86