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Drash syndrome(DDS)

MedGen UID:
181980
Concept ID:
C0950121
Disease or Syndrome
Synonyms: DDS; Denys-Drash Syndrome; Nephropathy associated with male pseudohermaphroditism and Wilms' tumor; NEPHROPATHY, WILMS TUMOR, AND GENITAL ANOMALIES; Pseudohermaphroditism, nephron disorder and Wilms' tumor; WILMS TUMOR AND PSEUDO- OR TRUE HERMAPHRODITISM; Wilms tumor and pseudohermaphroditism
SNOMED CT: Nephrotic syndrome with pseudohermaphroditism (236385009); Drash syndrome (236385009); Wilms' tumor and nephrotic syndrome with pseudohermaphroditism (236385009)
 
Gene (location): WT1 (11p13)
 
Monarch Initiative: MONDO:0008682
OMIM®: 194080
Orphanet: ORPHA220

Authors:

Additional descriptions

From OMIM
Denys-Drash syndrome (DDS) is characterized by urogenital abnormalities, progressive glomerulopathy, and the development of Wilms tumors in early childhood (summary by Antonius et al., 2008).  http://www.omim.org/entry/194080
From MedlinePlus Genetics
Denys-Drash syndrome is a condition that affects the kidneys and genitalia.

Denys-Drash syndrome is characterized by kidney disease that begins within the first few months of life. Affected individuals have a condition called diffuse glomerulosclerosis, in which scar tissue forms throughout glomeruli, which are the tiny blood vessels in the kidneys that filter waste from blood. In people with Denys-Drash syndrome, this condition often leads to kidney failure in childhood. People with Denys-Drash syndrome have an estimated 90 percent chance of developing a rare form of kidney cancer known as Wilms tumor. Affected individuals may develop multiple tumors in one or both kidneys.

Although males with Denys-Drash syndrome have the typical male chromosome pattern (46,XY), they have gonadal dysgenesis, in which external genitalia do not look clearly male or clearly female or the genitalia appear female-typical. The testes of affected males are undescended, which means they are abnormally located in the pelvis, abdomen, or groin. As a result, males with Denys-Drash are typically unable to have biological children (infertile).

Affected females usually have normal genitalia and have only the kidney features of the condition. Because they do not have all the features of the condition, females are usually given the diagnosis of isolated nephrotic syndrome.  https://medlineplus.gov/genetics/condition/denys-drash-syndrome

Clinical features

From HPO
Nephroblastoma
MedGen UID:
10221
Concept ID:
C0027708
Neoplastic Process
The presence of a nephroblastoma, which is a neoplasm of the kidney that primarily affects children.
Ovarian gonadoblastoma
MedGen UID:
309510
Concept ID:
C1518716
Neoplastic Process
The presence of a gonadoblastoma of the ovary.
Focal segmental glomerulosclerosis
MedGen UID:
4904
Concept ID:
C0017668
Disease or Syndrome
Segmental accumulation of scar tissue in individual (but not all) glomeruli.
Gonadal dysgenesis
MedGen UID:
9075
Concept ID:
C0018051
Congenital Abnormality
Gonadal dysgenesis is the name given to any of a multitude of conditions that can cause impaired development of the gonads, i.e., the testes or ovaries, or to the related phenotypic features. The term is to be avoided if possible for new annotations, and more specific terms should be chosen.
Kidney disorder
MedGen UID:
9635
Concept ID:
C0022658
Disease or Syndrome
A nonspecific term referring to disease or damage of the kidneys.
Nephrotic syndrome
MedGen UID:
10308
Concept ID:
C0027726
Disease or Syndrome
Nephrotic syndrome is a collection of findings resulting from glomerular dysfunction with an increase in glomerular capillary wall permeability associated with pronounced proteinuria. Nephrotic syndrome refers to the constellation of clinical findings that result from severe renal loss of protein, with Proteinuria and hypoalbuminemia, edema, and hyperlipidemia.
Male pseudohermaphroditism
MedGen UID:
68666
Concept ID:
C0238395
Congenital Abnormality
Hermaphroditism refers to a discrepancy between the morphology of the gonads and that of the external genitalia. In male pseudohermaphroditism, the genotype is male (XY) and the external genitalia are imcompletely virilized, ambiguous, or complete female. If gonads are present, they are testes.
True hermaphroditism
MedGen UID:
78595
Concept ID:
C0266361
Disease or Syndrome
The presence of both ovarian and testicular tissues either in the same or in opposite gonads. Affected persons have ambiguous genitalia and may have 46,XX or 46,XY karyotypes or 46,XX/XY mosaicism.
Uterus didelphys
MedGen UID:
82740
Concept ID:
C0266393
Congenital Abnormality
A malformation of the uterus in which the uterus is present as a paired organ as a result of the failure of fusion of the mullerian ducts during embryogenesis.
Septate vagina
MedGen UID:
82741
Concept ID:
C0266411
Congenital Abnormality
The presence of a vaginal septum, thereby creating a vaginal duplication. The septum is longitudinal in the majority of cases.
Diffuse mesangial sclerosis
MedGen UID:
78698
Concept ID:
C0268747
Disease or Syndrome
Diffuse sclerosis of the mesangium, as manifestated by diffuse mesangial matrix expansion.
Enlarged kidney
MedGen UID:
108156
Concept ID:
C0542518
Finding
An abnormal increase in the size of the kidney.
Gonadal tissue inappropriate for external genitalia or chromosomal sex
MedGen UID:
348064
Concept ID:
C1860268
Finding
Stage 5 chronic kidney disease
MedGen UID:
384526
Concept ID:
C2316810
Disease or Syndrome
A degree of kidney failure severe enough to require dialysis or kidney transplantation for survival characterized by a severe reduction in glomerular filtration rate (less than 15 ml/min/1.73 m2) and other manifestations including increased serum creatinine.
Ambiguous genitalia, male
MedGen UID:
867446
Concept ID:
C4021823
Finding
Ambiguous genitalia in an individual with XY genetic gender.
Ambiguous genitalia, female
MedGen UID:
892752
Concept ID:
C4025891
Congenital Abnormality
Ambiguous genitalia in an individual with XX genetic gender.
Hypertensive disorder
MedGen UID:
6969
Concept ID:
C0020538
Disease or Syndrome
The presence of chronic increased pressure in the systemic arterial system.
Congenital diaphragmatic hernia
MedGen UID:
68625
Concept ID:
C0235833
Congenital Abnormality
The presence of a hernia of the diaphragm present at birth.
Posterolateral diaphragmatic hernia
MedGen UID:
539426
Concept ID:
C0265700
Congenital Abnormality
A posterolateral defect in the diaphragm, commonly referred to as a Bochdalek hernia, which is often accompanied by herniation of the stomach, intestines, liver, and/or spleen into the chest cavity.
Wide anterior fontanel
MedGen UID:
400926
Concept ID:
C1866134
Finding
Enlargement of the anterior fontanelle with respect to age-dependent norms.
Neonatal respiratory distress
MedGen UID:
924182
Concept ID:
C4281993
Finding
Respiratory difficulty as newborn.
Epicanthus
MedGen UID:
151862
Concept ID:
C0678230
Congenital Abnormality
Epicanthus is a condition in which a fold of skin stretches from the upper to the lower eyelid, partially covering the inner canthus. Usher (1935) noted that epicanthus is a normal finding in the fetus of all races. Epicanthus also occurs in association with hereditary ptosis (110100).

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
Follow this link to review classifications for Drash syndrome in Orphanet.

Professional guidelines

PubMed

Sun S, Xu L, Bi Y, Wang J, Zhang Z, Tang X, Cao Q, Zhai Y, Chen J, Fang X, Liu J, Fang Y, Xiang T, Qian Y, Wu B, Wang H, Zhou W, Shen J, Dong K, Liu X, Zheng B, Zhang A, Wang X, Wu Y, Ma D, Shen Q, Rao J, Xu H
Eur J Med Genet 2020 Nov;63(11):104047. Epub 2020 Sep 4 doi: 10.1016/j.ejmg.2020.104047. PMID: 32891756
Millar AJW, Cox S, Davidson A
Pediatr Surg Int 2017 Jul;33(7):737-745. Epub 2017 May 17 doi: 10.1007/s00383-017-4091-6. PMID: 28516188
Millar AJ, Cox S, Davidson A
Pediatr Surg Int 2017 Apr;33(4):461-469. Epub 2017 Jan 4 doi: 10.1007/s00383-016-4047-2. PMID: 28054101

Recent clinical studies

Etiology

Lopez-Gonzalez M, Ariceta G
Pediatr Nephrol 2024 Sep;39(9):2601-2609. Epub 2024 Feb 7 doi: 10.1007/s00467-024-06302-y. PMID: 38326647
Aly R, Acharya R, Upadhyay KK
Hemodial Int 2023 Jan;27(1):E1-E4. Epub 2022 Oct 18 doi: 10.1111/hdi.13049. PMID: 36259088
Looijenga LH, Hersmus R, de Leeuw BH, Stoop H, Cools M, Oosterhuis JW, Drop SL, Wolffenbuttel KP
Best Pract Res Clin Endocrinol Metab 2010 Apr;24(2):291-310. doi: 10.1016/j.beem.2009.10.002. PMID: 20541153
Kucinskas L, Rudaitis S, Pundziene B, Just W
Medicina (Kaunas) 2005;41(2):132-4. PMID: 15758579
Hossain A, Saunders GF
Biol Reprod 2003 Dec;69(6):1808-14. Epub 2003 Jul 9 doi: 10.1095/biolreprod.103.015826. PMID: 12855602

Diagnosis

Lopez-Gonzalez M, Ariceta G
Pediatr Nephrol 2024 Sep;39(9):2601-2609. Epub 2024 Feb 7 doi: 10.1007/s00467-024-06302-y. PMID: 38326647
Berthaud R, Heidet L, Oualha M, Brat R, Talmud D, Garaix F, Rabant M, Frémeaux-Bacchi V, Antignac C, Boyer O, Dorval G
Pediatr Nephrol 2022 Nov;37(11):2637-2642. Epub 2022 May 4 doi: 10.1007/s00467-022-05537-x. PMID: 35507148
Looijenga LH, Hersmus R, de Leeuw BH, Stoop H, Cools M, Oosterhuis JW, Drop SL, Wolffenbuttel KP
Best Pract Res Clin Endocrinol Metab 2010 Apr;24(2):291-310. doi: 10.1016/j.beem.2009.10.002. PMID: 20541153
Alomari AI, Tham JC
Pediatr Nephrol 2006 Sep;21(9):1237-40. Epub 2006 Jul 6 doi: 10.1007/s00467-006-0182-7. PMID: 16823575
Mueller RF
J Med Genet 1994 Jun;31(6):471-7. doi: 10.1136/jmg.31.6.471. PMID: 8071974Free PMC Article

Therapy

Aly R, Acharya R, Upadhyay KK
Hemodial Int 2023 Jan;27(1):E1-E4. Epub 2022 Oct 18 doi: 10.1111/hdi.13049. PMID: 36259088
Brunel M, Leclerc-Mercier S, Barnier JP, Bille E, Sberro-Soussan R, Legendre C, Scemla A
Kidney Int 2019 Mar;95(3):721-722. doi: 10.1016/j.kint.2018.10.012. PMID: 30784666
Millar AJ, Cox S, Davidson A
Pediatr Surg Int 2017 Apr;33(4):461-469. Epub 2017 Jan 4 doi: 10.1007/s00383-016-4047-2. PMID: 28054101
Ogawa Y, Hagiwara M
Pharmacol Ther 2012 Jun;134(3):298-305. Epub 2012 Feb 9 doi: 10.1016/j.pharmthera.2012.02.001. PMID: 22342810
Stefanidis CJ, Querfeld U
Eur J Pediatr 2011 Nov;170(11):1377-83. Epub 2011 Feb 8 doi: 10.1007/s00431-011-1397-6. PMID: 21298518

Prognosis

Karmila AB, Yap YC, Appadurai M, Oh L, Fazarina M, Abd Ghani F, Ariffin H
Fetal Pediatr Pathol 2021 Apr;40(2):113-120. Epub 2019 Nov 9 doi: 10.1080/15513815.2019.1686788. PMID: 31707902
Millar AJW, Cox S, Davidson A
Pediatr Surg Int 2017 Jul;33(7):737-745. Epub 2017 May 17 doi: 10.1007/s00383-017-4091-6. PMID: 28516188
Millar AJ, Cox S, Davidson A
Pediatr Surg Int 2017 Apr;33(4):461-469. Epub 2017 Jan 4 doi: 10.1007/s00383-016-4047-2. PMID: 28054101
Hu M, Craig J, Howard N, Kan A, Chaitow J, Little D, Alexander SI
Pediatr Nephrol 2004 Oct;19(10):1160-3. Epub 2004 Jul 28 doi: 10.1007/s00467-004-1564-3. PMID: 15349765
Lin HC, Lin SK, Wen MC, Tseng CF, Fu LS, Chi CS
J Formos Med Assoc 2004 Jan;103(1):71-4. PMID: 15026863

Clinical prediction guides

Inoue S, Kondo A, Inoki Y, Ichikawa Y, Tanaka Y, Ueda C, Kitakado H, Suzuki R, Okada E, Sakakibara N, Horinouchi T, Nozu K
Clin Exp Nephrol 2024 Nov;28(11):1075-1081. Epub 2024 Jun 14 doi: 10.1007/s10157-024-02510-w. PMID: 38877226Free PMC Article
Aly R, Acharya R, Upadhyay KK
Hemodial Int 2023 Jan;27(1):E1-E4. Epub 2022 Oct 18 doi: 10.1111/hdi.13049. PMID: 36259088
Karmila AB, Yap YC, Appadurai M, Oh L, Fazarina M, Abd Ghani F, Ariffin H
Fetal Pediatr Pathol 2021 Apr;40(2):113-120. Epub 2019 Nov 9 doi: 10.1080/15513815.2019.1686788. PMID: 31707902
Niaudet P, Gubler MC
Pediatr Nephrol 2006 Nov;21(11):1653-60. Epub 2006 Aug 23 doi: 10.1007/s00467-006-0208-1. PMID: 16927106
Jaubert F, Vasiliu V, Patey-Mariaud de Serre N, Auber F, Jeanpierre C, Gubler MC, Nihoul-Fékété C, Fellous M
Arkh Patol 2003 Mar-Apr;65(2):40-4. PMID: 15357247

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