Detection of alport gene variants in children and young people with persistent haematuria

Background Genetic kidney disease is an important cause of persistent microscopic haematuria in children and young people. We aimed to determine the frequency of variants in the Alport syndrome genes ( COL4A3 , COL4A4 or COL4A5 ) in individuals under 18 years of age presenting with persistent microscopic haematuria to a single specialist centre in the United Kingdom over a 10-year period. Methods We conducted a retrospective longitudinal study of individuals referred to a tertiary paediatric nephrology service with persistent microscopic haematuria between April 2012 to 2022. Results 224 individuals (female 51.8%) were evaluated with persistent microscopic haematuria of greater than 6 months duration. The age at presentation was 7.5±4.3 years (mean±SD). Targeted exome sequencing was performed in 134 with 91 individuals (68%) identified to have a pathogenic or likely pathogenic variant in COL4A3 , COL4A4 or COL4A5 . Only 49.5% of individuals with identified variants had a family history of microscopic haematuria documented and 57.1% had additional proteinuria. COL4A5 was the commonest gene affected and missense variants affecting glycine residues were the most common variant type. Conclusion Over two thirds of children and young people who underwent genetic testing had an identifiable genetic basis for their microscopic haematuria and over half did not have a documented family history. Genetic testing should be part of the evaluation of persistent microscopic haematuria despite a negative family history.