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Urinary excretion of total cystine and the dibasic amino acids arginine, lysine and ornithine in relation to genetic findings in patients with cystinuria treated with sulfhydryl compounds

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Abstract

Advances in molecular genetics have brought a deeper understanding of cystinuria. This autosomal recessive disease, which is caused by a defective tubular reabsorption of cystine and the three dibasic amino acids arginine, lysine and ornithine, results in a lifelong risk of renal stone formation because of the low solubility of cystine in urine. Mutations detected within the two genes known to be associated with cystinuria, SLC3A1 (related to type I) and SLC7A9 (related to non-type I), cannot, however, in all cases explain the disease. Inasmuch as a high urinary concentration of cystine is the basis of stone formation in these patients, our aim was to measure urinary total cystine, arginine, lysine and ornithine, in patients currently lacking a full genetic explanation for their disease. Thirty-three patients with cystinuria who were on long-term treatment with tiopronin or D-penicillamine were divided into two groups. Group 1 comprised eight patients who carried mutation in one of the SLC3A1 alleles and two patients who completely lacked mutations both in the SLC3A1 and the SLC7A9 genes, that is genetic findings discordant with the increased urinary excretion of cystine and the dibasic amino acids in these patients. Group 2 comprised 23 patients homozygous for mutations within SLC3A1, that is genetic findings in accordance with the excretion pattern of classic type I cystinuria. When the two groups were compared, Group 1 had a significantly higher total urinary excretion of cystine (p<0.01) as well as of arginine, lysine and ornithine (p<0.05) than Group 2. Also, when the two patients without mutations were excluded from the calculations, there still was a significant difference in the urinary excretion of total cystine (p<0.05). This suggests that the two patients without any detected mutations in the two known cystine transport genes also contributed to the difference. These unexpected findings indicate that an additional gene or genes participate in the urinary cystine reabsorption in the cystinuric patients who currently are without a full genetic explanation for their disease.

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Acknowledgements

We thank all patients for their participation in this study. This investigation was supported by grants from FORSS (The Health Research Council in the South-East of Sweden), MFR (the Swedish Medical Research Council), Lisa and Johan Grönberg’s Research Fund and Skane County Council Research and Development Foundation. We wish to thank the late Mats Ekberg MD, Department of Internal Medicine, Hässleholm Hospital, Birger Lindergård MD, Department of Nephrology, Lund University Hospital, and Anders Christensson MD, Department of Nephrology and Transplantation, Malmö University Hospital, for valuable help in making the patients medical records available for this study. Ms Iréne Eriksson at the Renal Stone Unit, Division of Urology, Linköping University Hospital is acknowledged for managing patients and blood sampling. We also want to thank Mats Fredriksson, Department of Environmental Medicine, Linköping University Hospital for valuable statistical advice.

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Authors and Affiliations

  1. Department of Nephrology and Transplantation, Malmö University Hospital, 205 02 , Malmö, Sweden

    Erik Fjellstedt

  2. Division of Cell Biology, Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden

    Lotta Harnevik & Peter Söderkvist

  3. Department of Clinical Chemistry, Malmö University Hospital, Malmö, Sweden

    Jan-Olof Jeppsson

  4. Department of Urology, Huddinge University Hospital and Centre for Surgical Sciences, Karolinska Institutet, Stockholm, Sweden

    Hans-Göran Tiselius

  5. Division of Urology, Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping, Sweden

    Torsten Denneberg

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  1. Erik Fjellstedt
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  2. Lotta Harnevik
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  4. Hans-Göran Tiselius
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Correspondence to Erik Fjellstedt.

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Fjellstedt, E., Harnevik, L., Jeppsson, JO. et al. Urinary excretion of total cystine and the dibasic amino acids arginine, lysine and ornithine in relation to genetic findings in patients with cystinuria treated with sulfhydryl compounds. Urol Res 31, 417–425 (2003). https://doi.org/10.1007/s00240-003-0366-6

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