Following glomerular filtration, the bulk of solutes are reabsorbed in the proximal tubule to prevent excessive losses of vital metabolites. In this nephron segment, reabsorption is largely active via dedicated transporters. Hereditary defects in proximal tubular function are characterized by malabsorption affecting amino acids, glucose, potassium, phosphate, bicarbonate, low-molecular-weight proteins and other solutes handled by this nephron segment. Dysfunction may be isolated or generalized (Fanconi syndrome). Defects in specific transporters lead to increased urinary excretion of substrates, which are often diagnostic. In others, extrarenal gene expression causes a multisystem phenotype. In this review, we will give a short overview of the molecular genetics, clinical picture, pathophysiology and treatment of genetically defined proximal tubulopathies.

1.
Igarashi T, Sekine T, Inatomi J, Seki G: Unraveling the molecular pathogenesis of isolated proximal renal tubular acidosis. J Am Soc Nephrol 2002;13:2171–2177.
2.
Camargo SMR, Bockenhauer D, Kleta R: Aminoacidurias: clinical and molecular aspects. Kidney Int 2008;73:918–925.
3.
Chabrol B, Martens K, Meulemans S, Cano A, Jaeken J, Matthijs G, Creemers JWM: Deletion of C2orf34, PREPL and SLC3A1 causes atypical hypotonia-cystinuria syndrome. J Med Genet 2008;45:314–318.
4.
Santer R, Calado J: Familial renal glucosuria and SGLT2: From a Mendelian trait to a therapeutic target. Clin J Am Soc Nephrol 2010;5:133–141.
5.
Wright EM, Hirayama BA, Loo DF: Active sugar transport in health and disease. J Intern Med 2007;261:32–43.
6.
Kloeckener-Gruissem B, Vandekerckhove K, Nürnberg G, Neidhardt J, Zeitz C, Nürnberg P, Schipper I, Berger W: Mutation of solute carrier SLC16A12 associates with a syndrome combining juvenile cataract with microcornea and renal glucosuria. Am J Hum Genet 2008;82:772–779.
7.
Martin MG, Turk E, Lostao MO, Kerner C, Wright EM: Defects in Na+/glucose cotransporter (SGLT1) trafficking and function cause glucose-galactose malabsorption. Nat Genet 1996;12:216–220.
8.
Elsas LJ, Hillman RE, Patterson JH, Rosenberg LE: Renal and intestinal hexose transport in familial glucose-galactose malabsorption. J Clin Invest 1970;49:576–585.
9.
Santer R, Steinmann B, Schaub J: Fanconi-Bickel syndrome – a congenital defect of facilitative glucose transport. Curr Mol Med 2002;2:213–227.
10.
Furlan F, Santer R, Vismara E, Santus F, Sersale G, Menni F, Parini R: Bilateral nuclear cataracts as the first neonatal sign of Fanconi-Bickel syndrome. J Inherit Metab Dis 2006;29:685.
11.
Gräsbeck R: Imerslund-Gräsbeck syndrome (selective vitamin B12 malabsorption with proteinuria. Orphanet J Rare Dis 2006;1:17–22.
12.
Tanner SM, Li Z, Bisson R, Acar C, Öner C, Öner R, Çetin M, Abdelaal MA, Ismail EA, Lissens W, Krahe R, Broch H, Gräsbeck R, de la Chapelle A: Genetically heterogenous selective intestinal malabsorption of vitamin B12: founder effects, consanguinity, and high clinical awareness explain aggregations in Scandinavia and the Middle East. Hum Mutat 2004;23:327–333.
13.
Dent CE, Friedman M: Hypercalciuric rickets associated with renal tubular damage. Arch Dis Child 1964;39:240–249.
14.
Utsch B, Bökenkamp A, Benz M, Besbas N, Dötsch J, Franke I, Fründ S, Gok F, Hoppe B, Karle S, Kuwertz-Bröking E, Laube G, Neb M, Nuutinen M, Ozaltin F, Rascher W, Ring T, Tasic V, van Wijk JAE, Ludwig M: Novel OCRL1 mutations in patients with the phenotype of Dent disease. Am J Kidney Dis 2006;48:942–954.
15.
Carr G, Simmons NL, Sayer JA: Disruption of clc-5 leads to a redistribution of annexin A2 and promotes calcium crystal agglomeration in collecting duct epithelial cells. Cell Mol Life Sci 2006;63:367–377.
16.
Bökenkamp A, Böckenhauer D, Cheong HI, et al: Dent-2 disease: a mild variant of Lowe syndrome. J Pediatr 2009;155:94–99.
17.
Ludwig M, Utsch B, Monnens LAH: Recent advances in understanding the clinical and genetic heterogeneity of Dent’s disease. Nephrol Dial Transplant 2006;21:2708–2717.
18.
Hoopes RR Jr., Shrimpton AE, Knohl SJ, Hueber P, Hoppe B, Matyus J, Simckes A, Tasic V, Toenshoff B, Suchy SF, Nussbaum RL, Scheinman SJ: Dent disease with mutations in OCRL1. Am J Hum Genet 2005;76:260–267.
19.
Bockenhauer, Bokenkamp A, van’t Hoff W, Levtchenko E, Kist-van Holthe JE, Tasic V, Ludwig M: Renal phenotype in Lowe syndrome: a selective proximal tubular dysfunction. Clin J Am Soc Nephrol 2008;3:1430–1436.
20.
Loi M: Lowe syndrome. Orphanet J Rare Dis 2006;1:16.
21.
Lowe M: Structure and function of the Lowe syndrome protein OCRL1. Traffic 2005;9:711–719.
22.
Monnier N, Satre V, Lerouge E, Berthoin F, Lunardi J: OCRL1 mutation analysis in French Lowe syndrome patients: implications for molecular diagnosis strategy and genetic counseling. Hum Mutat 2000;16:157–165.
23.
Nesterova G, Gahl W: Nephropathic cystinosis: late complications of a multisystemic disease. Pediatr Nephrol 2008;23:863–878.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.