Mutations in ACTN4, encoding alpha-actinin-4, cause familial focal segmental glomerulosclerosis.

Focal and segmental glomerulosclerosis (FSGS) is a common, non-specific renal lesion. Although it is often secondary to other disorders, including HIV infection, obesity, hypertension and diabetes, FSGS also appears as an isolated, idiopathic condition. FSGS is characterized by increased urinary protein excretion and decreasing kidney function. Often, renal insufficiency in affected patients progresses to end-stage renal failure, a highly morbid state requiring either dialysis therapy or kidney transplantation. Here we present evidence implicating mutations in the gene encoding alpha-actinin-4 (ACTN4; ref. 2), an actin-filament crosslinking protein, as the cause of disease in three families with an autosomal dominant form of FSGS. In vitro, mutant alpha-actinin-4 binds filamentous actin (F-actin) more strongly than does wild-type alpha-actinin-4. Regulation of the actin cytoskeleton of glomerular podocytes may be altered in this group of patients. Our results have implications for understanding the role of the cytoskeleton in the pathophysiology of kidney disease and may lead to a better understanding of the genetic basis of susceptibility to kidney damage.

Parvoviral infection associated with increased nuchal translucency: a case report.

An increased fetal nuchal translucency detected by first trimester ultrasound has been associated with an elevated risk of aneuploidy. The etiology of the increased nuchal translucency in fetuses with normal chromosomes is uncertain, but it has been associated with poor pregnancy outcome. We report a fetus with increased nuchal translucency and a normal karyotype, in which parvovirus was detected by polymerase chain reaction in the amniotic fluid. Although an ultrasound detected an increased nuchal fold thickness in the second trimester, the pregnancy was otherwise uncomplicated. Parvovirus should be considered as a possible etiology of increased nuchal translucency. The risks to a fetus with first trimester parvovirus infections diagnosed under these conditions are uncertain and require larger studies.

Sex differences in leukocyte invasion in injured murine skeletal muscle.

The three aims of this study were to describe the time course of leukocyte invasion in injured soleus muscles of male and female mice, to determine if differential subsets of leukocytes accumulate in intramyofiber and interstitial sites, and to determine if significant sex differences exist in invading leukocyte concentrations. Fifty sexually mature C57BL/6J mice (aged 11-12 weeks) underwent unilateral hindlimb muscle injury induced by lengthening contractions. This procedure models the muscle injury that can occur through strenuous exercise or overuse in humans. After 1, 3, 5, or 7 days of recovery, the injured and contralateral, uninjured solei were dissected and prepared for morphologic analysis. We found that leukocytes had invaded injured myofibers at 1-day postinjury for both sexes. Different subsets of leukocytes accumulated within damaged myofibers and the interstitium. Significantly fewer myofibers were invaded by acid phosphatase-positive leukocytes in females. Interstitial ER-BMDM1 leukocyte concentrations peaked in females at 7 days postinjury in comparison to 5 days postinjury in males. These findings expand nursing's knowledge base regarding the potential effect of gender on recovery from acute muscle injury.