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Alabdulqader M, Alfakeeh K. A patient with a homozygous diacylglycerol kinase epsilon (DGKE) gene mutation with atypical haemolytic uraemic syndrome and low C3 responded well to eculizumab: a case report. BMC Nephrol. 2021;22(1):140doi: 10.1186/s12882-021-02352-8.
Alabdulqader, M., & Alfakeeh, K. (2021). A patient with a homozygous diacylglycerol kinase epsilon (DGKE) gene mutation with atypical haemolytic uraemic syndrome and low C3 responded well to eculizumab: a case report. BMC nephrology, 22(1), 140. https://doi.org/10.1186/s12882-021-02352-8
Alabdulqader, Muneera, and Alfakeeh, Khalid. "A patient with a homozygous diacylglycerol kinase epsilon (DGKE) gene mutation with atypical haemolytic uraemic syndrome and low C3 responded well to eculizumab: a case report." BMC nephrology vol. 22,1 (2021): 140. doi: https://doi.org/10.1186/s12882-021-02352-8
Alabdulqader M, Alfakeeh K. A patient with a homozygous diacylglycerol kinase epsilon (DGKE) gene mutation with atypical haemolytic uraemic syndrome and low C3 responded well to eculizumab: a case report. BMC Nephrol. 2021 Apr 20;22(1):140. doi: 10.1186/s12882-021-02352-8. PMID: 33879077; PMCID: PMC8056694.
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BMC Nephrol. 2021 Apr 20;22(1):140. doi: 10.1186/s12882-021-02352-8.

A patient with a homozygous diacylglycerol kinase epsilon (DGKE) gene mutation with atypical haemolytic uraemic syndrome and low C3 responded well to eculizumab: a case report.

BMC nephrology

Muneera Alabdulqader, Khalid Alfakeeh

Affiliations

  1. Department of Paediatrics, College of Medicine, King Faisal University, Alhasa, Saudi Arabia. [email protected].
  2. Department Paediatric Nephrology, King Abdullah Specialists Children Hospital, Riyadh, Saudi Arabia.

PMID: 33879077 PMCID: PMC8056694 DOI: 10.1186/s12882-021-02352-8

Abstract

BACKGROUND: Atypical haemolytic uraemic syndrome (aHUS) is a rare systemic syndrome characterized by non-immune haemolytic anaemia, thrombocytopenia, and kidney injury. In most cases, alternative complement pathway dysregulation is the identifying cause. Recently, other genetic causes have been identified, including a mutation in the diacylglycerol kinase epsilon (DGKE) gene, which theoretically affect the coagulation pathway and does not affect the complement pathway. Data about the management of these patients are limited. Ideal management and definitive treatment protocols have not yet been established.

CASE PRESENTATION: A three-year-old boy presented with features of atypical haemolytic uraemic syndrome (aHUS) and low complement C3. He was presumed to have complement-mediated aHUS and was managed empirically with eculizumab. Two weeks after starting eculizumab, his haemoglobin levels, platelet count, and complement C3 level normalized but he continued to have non-nephrotic range proteinuria. His genetic testing revealed a homozygous DGKE mutation, with no other mutation detected. Six months after presentation, the patient was still in remission with no features of aHUS, a trial of weaning eculizumab by increasing dose interval was followed by nephrotic range proteinuria and severe oedema. His proteinuria improved and his oedema resolved after resuming his recommended eculizumab dose.

CONCLUSIONS: DGKE gene mutation can lead to aHUS with theoretically no complement dysregulation. However, some patients with this mutation show alternative complement pathway activation. This case report describes a patient with aHUS due to a DGKE gene mutation and low C3 levels who responded to eculizumab, adding to the previously reported cases of patients with DGKE gene mutations who had complete remission with no relapse with C5 blockers and/or plasma exchange. A randomized controlled study on patients with DGKE mutations might be beneficial in understanding the disease and generating a management protocol.

Keywords: DGKE mutation; Eculizumab; Haemolytic uraemic syndrome

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