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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Molecular PKDTS characterization in the three TSC patients&#46; &#40;A&#41; Schematic representation of the deletions detected by MLPA in the three PKDTS cases &#40;not drawn to scale&#41;&#46; Vertical gray lines in the <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> genes indicate exons with proportional spacing&#46; The long black lines above indicate the range of each heterozygous deletion&#46; A short dotted arrow and a question mark represent the expected minimal deletion interval estimated by MLPA&#46; &#40;B&#41; Schematic representation of the rearrangement detected in the 16p13&#46;3 region by CMA in case 3 &#40;not drawn to scale&#41;&#46; Gray lines at the right indicate deleted coding genes &#40;complete deletion of <span class="elsevierStyleItalic">TSC2</span> and deletion of exons 20&#8211;46 of <span class="elsevierStyleItalic">PKD1</span>&#41; and double gray lines at the left indicate the duplicated coding genes &#40;three copies&#41;&#44; including <span class="elsevierStyleItalic">SSTR5</span>&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; Cen&#58; centromeric region&#44; CMA&#58; chromosomal microarray analysis&#44; Ex&#58; exon&#44; MLPA&#58; multiplex ligation-dependent probe amplification&#44; Tel&#58; telomeric region&#46;</p>"
        ]
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberous sclerosis complex &#40;TSC&#44; MIM&#35;191100&#41; is an autosomal dominant disorder that is characterized by the development of multiple hamartomas and is caused by heterozygous pathogenic variants in the tumor suppressor genes&#44; <span class="elsevierStyleItalic">TSC1</span> or <span class="elsevierStyleItalic">TSC2</span>&#46; The most common renal lesions are angiomyolipomas&#44; occurring in &#62;80&#37; of the patients and frequently presented as multiple and bilateral&#46; Besides&#44; approximately 14&#8211;32&#37; of the TSC cases exhibit some degree of renal cyst formation&#44; most of which occurs in the second decade of life&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Early development of multiple renal cysts with kidney enlargement in TSC patients is associated with the heterozygous contiguous deletion of <span class="elsevierStyleItalic">TSC2</span> and the adjacent <span class="elsevierStyleItalic">PKD1</span> gene&#59; this last is the causative for autosomal dominant polycystic kidney disease &#40;ADPKD&#44; MIM&#35;173900&#41;&#46; The <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> contiguous gene syndrome &#40;PKDTS&#44; MIM &#35;600273&#41; reportedly comprises ~2&#8211;5&#37; of all TSC cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> These patients should be diagnosed as early as possible due to the <span class="elsevierStyleItalic">PKD1</span> deletion that increases the risk for ADPKD-related complications such as cystic kidney disease&#44; hepatic and pancreatic cysts&#44; arterial hypertension&#44; intracranial aneurysm<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;5</span></a> and to the probability of presenting an early end-stage renal disease &#40;20&#8211;30 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Molecular analysis is crucial for the early and confirmed diagnosis of PKDTS&#44; which allows clinicians to assess for the progressive renal lesions and other potentially fatal ADPKD-related complications&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> To date&#44; more than 65 molecularly characterized cases of PKDTS have been reported &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;8&#8211;16</span></a> However&#44; the precise deletion interval has only been identified in a few of these patients&#44; and no clear genotype&#8211;phenotype correlation has been established&#46; Hence&#44; we need to describe more PKDTS patients and their responsible genotypes in order to identify possible genotype&#8211;phenotype correlations and&#47;or the mechanisms underlying the phenotypic variability of PKDTS&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case presentation</span><p id="par0015" class="elsevierStylePara elsevierViewall">Herein we describe three unrelated Mexican pediatric patients who fulfilled the criteria of Northrup et al&#46; for a definitive diagnosis of TSC &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Written informed consent was obtained for all cases and the five available parents&#44; besides&#44; the study protocol was revised and approved by the local ethics committee &#40;reference number 060&#47;2014&#41;&#46; DNA samples were acquired from peripheral blood leukocytes by standard <span class="elsevierStyleItalic">in silica</span> adsorption method&#46; At the time of admission&#44; cases 1 and 2 revealed multiple bilateral renal cysts on ultrasonography &#40;US&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>A and B&#41;&#46; Since this suggested a classic PKDTS phenotype&#44; these cases were subjected to a multiplex ligation-dependent probe amplification &#40;MLPA&#41; assay &#40;SALSA MLPA&#174; P337 TSC2 probemix&#44; Lot 0510-A2&#59; MRC-Holland Amsterdam&#44; The Netherlands&#41; that included 39 probes for <span class="elsevierStyleItalic">TSC2</span> and one probe for <span class="elsevierStyleItalic">PKD1</span> &#40;exon 40&#41;&#46; The MLPA results revealed a deletion involving exons 31&#8211;42 from <span class="elsevierStyleItalic">TSC2</span> and at least exons 40&#8211;46 from <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>A&#41; in both cases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">For case 3&#44; a single cyst &#40;&#60;10<span class="elsevierStyleHsp" style=""></span>mm&#41; in the right kidney was identified by US at 4 years of age&#44; and follow-up US examinations yielded similar results &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>C&#41;&#46; It should be noted that the molecular protocol carried out in this case 3 started with a direct Sanger sequencing &#40;SS&#41; of all coding exons and the exon&#8211;intron boundaries of <span class="elsevierStyleItalic">TSC1</span> and <span class="elsevierStyleItalic">TSC2</span> since there was no clinical suspicious of PKDTS due to the presence of a single renal cyst&#46; As the SS results did not reveal any pathogenic variant a MLPA methodology was implemented and it revealed the presence of a large deletion that comprised all coding exons of <span class="elsevierStyleItalic">TSC2</span> and at least exons 40&#8211;46 of <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>A&#41;&#46; Based on this genotype&#44; a posteriori magnetic resonance imaging &#40;MRI&#41; was performed at age 15 to intentionally search for multiple renal cysts&#46; The MRI results exposed more than 25 small cysts of variable size &#40;9<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD 5&#46;39<span class="elsevierStyleHsp" style=""></span>mm&#41; in both kidneys &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>D&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To clarify the size and exact breakpoints of the deleted region in case 3&#44; we performed chromosomal microarray &#40;CMA&#41; analysis &#40;CytoScan&#8482; High Density Microarray&#59; Affymetrix&#44; Inc&#46;&#44; Santa Clara&#44; CA&#44; USA&#41; using the Human Genome Assembly hg38 for the analysis&#46; We detected a 230&#46;8<span class="elsevierStyleHsp" style=""></span>kb heterozygous deletion that encompassed 13 coding genes&#44; including all of <span class="elsevierStyleItalic">TSC2</span> and part of <span class="elsevierStyleItalic">PKD1</span> &#40;exons 20&#8211;46&#41;&#44; along with a neighboring heterozygous duplication of a previously undescribed CNV &#40;242&#46;9<span class="elsevierStyleHsp" style=""></span>kb&#41; in the 16p13&#46;3 region that included six coding genes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>B&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the time of last evaluation&#44; renal function was preserved in all three cases&#44; although cases 2 and 3 had elevated glomerular filtration rates&#44; and case 1 had microscopic hematuria without proteinuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; None of the three cases presented intracranial aneurysm &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; Both parents of all three patients had normal findings on clinical examination&#44; cerebral computed tomography and renal US&#44; while five had normal MLPA <span class="elsevierStyleItalic">TSC2</span> results&#46; Thus&#44; only two out of the three PKDTS cases identified herein were considered as <span class="elsevierStyleItalic">the novo</span> since DNA was not available for testing in the father of case 2&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The three studied cases displayed multiple renal cysts&#46; Cases 1 and 2 were consistent with a classic PKDTS phenotype&#58; large kidney cysts were identified by US at an early stage and predominated over angiomyolipomas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>A and B&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; These two cases appeared to exhibit the same partial heterozygous deletion of <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span>&#44; although the exact 5&#180; deletion breakpoint in <span class="elsevierStyleItalic">PKD1</span> was not identified by the employed MLPA assay &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>A&#41;&#46; To date&#44; 30 PKDTS cases have been described in which the contiguous deletion affects parts of <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#46; In general&#44; regardless of the extent of the deletion&#44; the renal cysts were larger and the renal function fell below normal at a younger age than seen in typical TSC cases without any <span class="elsevierStyleItalic">PKD1</span> deletion&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Unexpectedly&#44; case 3 exhibited small cysts that could only be detected by MRI&#44; which is better able to detect small cysts &#40;&#60;1<span class="elsevierStyleHsp" style=""></span>cm&#41; in ADPKD patients compared to US&#44; although the latter is the initial test of choice in the polycystic kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">To date&#44; at least 25 other PKDTS cases have been reported to include deletion of genes in addition to <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#59; among them&#44; our case 3 appears to harbor the largest deletion upstream of <span class="elsevierStyleItalic">TSC2</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>B&#41;&#46; In three of the previously reported cases&#44; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41; the early PKD symptoms and end-stage renal disease were recognized fairly late &#40;&#62;20 years&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;11&#44;12</span></a> This is similar to case 3&#44; in which only a few small cysts were found at age 15 and renal function was preserved &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; The previous authors speculated that the relatively mild kidney involvement could reflect somatic mosaicism or the presence of genetic modifiers&#44; but these hypotheses were not tested&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Other studies have suggested that a mild PKD phenotype &#40;better preserved renal function&#44; as evaluated by glomerular filtration rate&#44; and cystic disease recognized only in adult life&#41; is associated with low&#47;high grade deletion mosaicism&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10&#44;11</span></a> However&#44; the apparently mild PKD phenotype in case 3 could not be explained by somatic mosaicism&#44; as the MLPA results showed that the ratio values &#40;STD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;10&#41; for each probe involved in the <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> contiguous deletion were reduced by 0&#46;5&#44; implying that 100&#37; of the peripheral leukocyte cells were heterozygous for this genotype and in addition&#44; we detected a smooth signal of 1&#46;2 copies &#40;heterozygous deletion genotype&#41; in CMA data&#46; However&#44; a low-level mosaicism could not be totally ruled out by CMA data since the deletion size is very small and the CytoScan<span class="elsevierStyleSup">TM</span> algorithm is designed to discard mosaicism by the analysis of at least 5000 markers in deleted region&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The variable progression of PKD in our patients and the reported cases plus the absence of a clear genotype&#8211;phenotype correlation suggest that the mechanisms underlying renal cyst formation in PKD are extremely complex and may involve environmental and&#47;or genetic factors that are not solely related to the <span class="elsevierStyleItalic">PKD</span> genotype&#46; The identified 296&#46;7<span class="elsevierStyleHsp" style=""></span>kb CNV in the 16p13&#46;3 region of case 3&#44; which had not been previously reported as pathogenic in Decipher<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> or the Database of Genomic Variants&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> included six coding genes and remarkable among them is the <span class="elsevierStyleItalic">SSTR5</span> &#40;somatostatin receptor&#41; gene&#46; Although&#44; small clinical trials showed that somatostatin analogs &#40;SSAs&#41; decreased total kidney volume in patients with ADPKD&#44; larger trials are ongoing to know their final effect in kidney cysts&#44; so at this time&#44; they are only indicated in ADPKD patients with severe liver cystic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#8211;25</span></a> The precise mechanism through which SSAs &#40;e&#46;g&#46;&#44; lanreotide and octreotide&#41; inhibit cystogenesis is not fully understood&#44; but SSAs can inhibit cAMP accumulation&#44; which plays a crucial role in cystogenesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a> We hypothesize that the triple gene dosage of <span class="elsevierStyleItalic">SSTR5</span> correlates with increased binding of the receptor&#39;s ligand&#44; which would further reduce intracellular cAMP levels and decrease cellular proliferation through the Ras&#47;Raf&#47;MEK&#47;ERK pathways&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Modifier genes have previously been proposed to be present within CNVs of monogenic disorders&#46; For example&#44; Artuso et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> detected a CNV containing a candidate modifier gene for Rett syndrome &#40;MIM&#35;312750&#41;&#46; In two sisters with the same pathogenic genotype of <span class="elsevierStyleItalic">MECP2</span> &#40;the gene responsible for Rett syndrome&#41;&#44; the three copies of <span class="elsevierStyleItalic">CROCC</span> &#40;1p36&#46;13&#41; was associated with a milder phenotype&#44; while a single gene copy was associated with the classic phenotype of Rett syndrome&#46; Thus&#44; it can be hypothesized that the presence of the CNV with the three <span class="elsevierStyleItalic">SSTR5</span> copies in our case 3 may counteract the <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> deletion and modulate the PKD severity&#46; However&#44; future work is warranted to examine this possibility&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the other hand&#44; we can neither rule out that in case 3 the heterozygous loss of any of the 13 coding genes&#44; others than <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span>&#44; could act as disease modifier&#46; In fact&#44; it has been shown that some of these genes are expressed in the kidney&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> although none has been involved in a syndrome associating with kidney alterations in OMIM&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0060" class="elsevierStylePara elsevierViewall">The cystic phenotype in PKDTS cases varies considerable among individuals&#59; this suggests that a combination of factors besides the <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> genotype&#44; as modifying genes could be implied in the progression of the disease&#46; Given the reported effect of SSAs in cystogenesis and the presence of three copies of <span class="elsevierStyleItalic">SSTR5</span> in the patient who exhibited the mildest PKD phenotype &#40;case 3&#41; we hypothesize that an increased gene dosage of <span class="elsevierStyleItalic">SSTR5</span> could counteract the PKD phenotype and its progression&#46; The main limitation of our work relies on the fact that the exact 5&#39;<span class="elsevierStyleItalic">PKD1</span> breakpoint in cases 1 and 2 could not be determined&#44; however&#44; these two cases presented multiple cysts in both kidneys at early age as expected with a classic PKDTS&#46; Considering that no previous studies have reported possible modifier genetic variants in other PKDTS patients&#44; future work that includes functional analyses&#44; frequency population studies in healthy individuals and more PKDTS cases will be necessary to determine the role of the 16p13&#46;3 CNV&#44; that contains <span class="elsevierStyleItalic">SSTR5</span> in case 3 which apparently harbors the largest <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> deletion and the mildest PKDTS phenotype&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study was supported by the research funding from the National Institute of Pediatrics&#44; Ciudad de M&#233;xico&#44; M&#233;xico &#40;Recursos Fiscales del Programa E022&#41;&#44; as well as funding from Consejo Nacional de Ciencia y Tecnolog&#237;a&#44; M&#233;xico &#40;CONACyT FONSEC SSA&#47;IMSS&#47;ISSSTE&#44; S0008&#44; 2016&#8211;2018&#44; Project &#35;261404&#41;&#44; Fundaci&#243;n &#8220;Miguel Alem&#225;n&#8221; 2012 and Novartis &#40;2013&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interests&#46;</p></span></span>"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Tuberous sclerosis complex"
            1 => "Polycystic kidney disease"
            2 => "Copy number variant"
            3 => "<span class="elsevierStyleItalic">TSC2</span>&#47;<span class="elsevierStyleItalic">PKD1</span> contiguous gene syndrome"
            4 => "<span class="elsevierStyleItalic">SSTR5</span> gene"
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          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1216595"
          "palabras" => array:8 [
            0 => "ADPKD"
            1 => "CNV"
            2 => "CMA"
            3 => "MLPA"
            4 => "PKD"
            5 => "PKDTS"
            6 => "SSAs"
            7 => "TSC"
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          "palabras" => array:5 [
            0 => "Complejo de esclerosis tuberosa"
            1 => "Enfermedad del ri&#241;&#243;n poliqu&#237;stico"
            2 => "Variante del n&#250;mero de copias"
            3 => "S&#237;ndrome de genes contiguos <span class="elsevierStyleItalic">TSC2</span>&#47;<span class="elsevierStyleItalic">PKD1</span>"
            4 => "Gen <span class="elsevierStyleItalic">SSTR5</span>"
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          "identificador" => "xpalclavsec1216596"
          "palabras" => array:3 [
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            2 => "PKDTS"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">About 80&#37; of patients with tuberous sclerosis complex &#40;TSC&#41; present renal involvement&#44; usually as angiomyolipomas followed by cystic disease&#46; An early diagnosis of polycystic kidney disease &#40;PKD&#41; in such patients is frequently related to the <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> contiguous gene syndrome &#40;PKDTS&#41;&#46; Molecular confirmation of PKDTS is important for a prompt diagnosis&#44; which can be complicated by the phenotypic heterogeneity of PKD and the absence of a clear phenotype&#8211;genotype correlation&#46; Herein&#44; we report three PKDTS pediatric patients&#46; The case 3 did not present a classic PKDTS phenotype&#44; having only one observable cyst on renal ultrasound at age 4 and multiple small cysts on magnetic resonance imaging at age 15&#46; In this patient&#44; chromosomal microarray analysis showed a gross deletion of 230&#46;8<span class="elsevierStyleHsp" style=""></span>kb that involved <span class="elsevierStyleItalic">TSC2</span>&#44; <span class="elsevierStyleItalic">PKD1</span> and 13 other protein-coding genes&#44; plus a heterozygous duplication of a previously undescribed copy number variant of 242&#46;9<span class="elsevierStyleHsp" style=""></span>kb that involved six protein-coding genes&#44; including <span class="elsevierStyleItalic">SSTR5</span>&#44; in the 16p13&#46;3 region&#46; Given the observations that the case 3 presented the mildest renal phenotype&#44; harbored three copies of <span class="elsevierStyleItalic">SSTR5&#44;</span> and the reported inhibition of cystogenesis &#40;specially in liver&#41; observed with somatostatin analogs in some patients with autosomal dominant PKD&#44; it can be hypothesized that other genetic factors as the gene dosage of <span class="elsevierStyleItalic">SSTR5</span> may influence the PKD phenotype and the progression of the disease&#59; however&#44; future work is needed to examine this possibility&#46;</p></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un 80&#37; de los pacientes con complejo de esclerosis tuberosa &#40;CET&#41; presentan afectaci&#243;n renal&#44; generalmente angiomiolipomas&#44; seguidos de enfermedad qu&#237;stica&#46; Un diagn&#243;stico temprano de la enfermedad renal poliqu&#237;stica &#40;ERP&#41; en estos pacientes se relaciona con frecuencia con el s&#237;ndrome de genes contiguos <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> &#40;PKDTS&#41;&#46; La confirmaci&#243;n molecular de PKDTS es importante para establecer un diagn&#243;stico oportuno&#44; que puede complicarse por la heterogeneidad fenot&#237;pica de PKD y la ausencia de una clara correlaci&#243;n entre fenotipo y genotipo&#46; En este art&#237;culo presentamos los casos de 3 pacientes pedi&#225;tricos con PKDTS&#46; El caso 3 no present&#243; un fenotipo PKDTS cl&#225;sico&#44; con solo un quiste observable en la ecograf&#237;a renal a los 4 a&#241;os y numerosos quistes peque&#241;os en la resonancia magn&#233;tica a los 15 a&#241;os&#46; En este paciente&#44; el an&#225;lisis de microarreglos para an&#225;lisis cromos&#243;mico global mostr&#243; una eliminaci&#243;n total de 230&#44;8<span class="elsevierStyleHsp" style=""></span>kb que involucr&#243; a <span class="elsevierStyleItalic">TSC2&#44;</span><span class="elsevierStyleItalic">PKD1</span> y otros 13 genes codificantes de prote&#237;nas&#44; m&#225;s una duplicaci&#243;n heterocigota para una variante de n&#250;mero de copias no descrita previamente de 242&#44;9<span class="elsevierStyleHsp" style=""></span>kb que involucr&#243; a 6 genes codificantes de prote&#237;nas&#44; entre ellos <span class="elsevierStyleItalic">SSTR5&#44;</span> en la regi&#243;n 16p13&#46;3&#46; Dado que el caso 3 mostraba el fenotipo renal menos severo&#44; contaba con tres copias del gen <span class="elsevierStyleItalic">SSTR5</span> y a que se ha observado una inhibici&#243;n en la cistog&#233;nesis &#40;especialmente en el h&#237;gado&#41; con los an&#225;logos de somatostatina en algunos pacientes con ERP autos&#243;mica dominante&#44; podemos hipotetizar que existen otros factores gen&#233;ticos como la dosis g&#233;nica de <span class="elsevierStyleItalic">SSTR5</span> que pudieran influir en el fenotipo y la progresi&#243;n de la ERP&#59; sin embargo&#44; se necesitan estudios adicionales para investigar esta posibilidad&#46;</p></span>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3808
            "Ancho" => 2934
            "Tamanyo" => 656108
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">TS</span>C2 and <span class="elsevierStyleItalic">PKD1</span> deletions characterized by various molecular techniques in the reported PKDTS cases&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="202003180710049251"></elsevierMultimedia>&#44; Complete deletion of the gene&#59; <elsevierMultimedia ident="202003180710049252"></elsevierMultimedia>&#44; partial deletion of the gene&#59; &#63;&#44; Unknown breakpoint&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; aCGH&#58; microarray-based comparative genomic hybridization&#59; CMA&#58; chromosomal microarray&#59; FISH&#58; fluorescence <span class="elsevierStyleItalic">in situ</span> hybridization&#59; MLPA&#58; multiplex ligation-dependent probe amplification&#59; qPCR&#58; quantitative PCR&#44; &#42;Cases in which PKD symptoms and end-stage renal disease were recognized fairly late &#40;&#62;20 years&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1777
            "Ancho" => 2126
            "Tamanyo" => 296331
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Renal image studies in the three TSC patients&#46; &#40;A and B&#41; Polycystic kidney disease detected by US in cases 1 and 2&#46; &#40;C&#41; Single cyst in the right kidney detected by US in case 3 &#40;arrows&#41;&#46; &#40;D&#41; Polycystic kidney disease detected by MRI in case 3&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1754
            "Ancho" => 2514
            "Tamanyo" => 186438
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Molecular PKDTS characterization in the three TSC patients&#46; &#40;A&#41; Schematic representation of the deletions detected by MLPA in the three PKDTS cases &#40;not drawn to scale&#41;&#46; Vertical gray lines in the <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> genes indicate exons with proportional spacing&#46; The long black lines above indicate the range of each heterozygous deletion&#46; A short dotted arrow and a question mark represent the expected minimal deletion interval estimated by MLPA&#46; &#40;B&#41; Schematic representation of the rearrangement detected in the 16p13&#46;3 region by CMA in case 3 &#40;not drawn to scale&#41;&#46; Gray lines at the right indicate deleted coding genes &#40;complete deletion of <span class="elsevierStyleItalic">TSC2</span> and deletion of exons 20&#8211;46 of <span class="elsevierStyleItalic">PKD1</span>&#41; and double gray lines at the left indicate the duplicated coding genes &#40;three copies&#41;&#44; including <span class="elsevierStyleItalic">SSTR5</span>&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; Cen&#58; centromeric region&#44; CMA&#58; chromosomal microarray analysis&#44; Ex&#58; exon&#44; MLPA&#58; multiplex ligation-dependent probe amplification&#44; Tel&#58; telomeric region&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">All cases are definitive according to the criteria of Northrup et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Seizures are well controlled in all three cases&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CMA&#58; chromosomal microarray&#59; eGFR&#58; estimated glomerular filtration rate&#59; m&#58; months&#59; MLPA&#58; multiple ligation probe amplification&#59; NA&#58; not analyzed&#59; y&#58; years&#59; &#43;&#58; present&#59; -&#58; absent&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age at hospital admission&#47;PKD diagnosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Current age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18y&#44; 5m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18y&#44; 9m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15y&#44; 8m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC major features</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypomelanotic macules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angiofibromas &#40;&#61;3&#41; or fibrous cephalic plaque&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ungual fibromas &#40;&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Shagreen patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple retinal hamartomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cortical dysplasias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subependymal nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subependymal giant cell astrocytoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac rhabdomyoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphangioleiomyomatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angiomyolipomas &#40;&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC minor features</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Confetti skin lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dental enamel pits &#40;&#62;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intraoral fibromas &#40;&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retinal achromic patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple renal cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nonrenal hamartomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Other clinical findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Seizures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intellectual disability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Central nervous system alterations&#44; aneurysms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 16y&#44; 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 15y&#44; 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 11y&#44; 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Liver cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 14y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 18y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 13y&#44; 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kidney findings at last evaluation age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16y&#44; 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10y&#44; 9m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13y&#44; 2m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>eGFR<a class="elsevierStyleCrossRef" href="#tblfn0020">&#42;</a> &#40;normal 90&#8211;120<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Blood pressure &#40;systolic&#47;diastolic PC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hemoglobin &#40;12&#8211;15</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Uric acid &#40;2&#46;4&#8211;5&#46;9</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Proteinuria &#40;urinary protein to creatinine ratio</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">0&#46;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematuria &#40;2&#8211;5 RBCs&#47;high power field&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;positive&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#37; Kidney growth per year</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Molecular studies</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Deleted region by MLPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TSC2</span> &#40;Exons 31&#8211;42&#41;&#44; <span class="elsevierStyleItalic">PKD1</span> &#40;Exons 46&#8211;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC2</span> &#40;Exons 31&#8211;42&#41;&#44; <span class="elsevierStyleItalic">PKD1</span> &#40;Exons 46&#8211;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TSC2</span> &#40;whole gene deletion&#41;&#44; <span class="elsevierStyleItalic">PKD1</span> &#40;Exons 20&#8211;46&#41;&#44; exact breakpoint further delineated by CMA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Deleted region by CMA&#47;deleted genes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">arr&#91;hg38&#93; 16p13&#46;3&#40;1&#44;875&#44;332&#8211;2&#44;106&#44;147&#41;x1&#47;HS3ST6&#44; MSRB1&#44; RPL3L&#44; NDUFB10&#44; RPS2&#44; RNF151&#44; NOXO1&#44; GFER&#44; SYNGR3&#44; ZNF598&#44; NPW&#44; SLC9A3R2&#44; NTHL1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duplicated region by CMA&#47;duplicated genes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">arr&#91;hg38&#93; 16p13&#46;3&#40;1&#44;002&#44;307-1&#44;245&#44;192&#41;x3&#47;SSTR5&#44; C1QTNF8&#44; CACNA1H&#44; TPSG1&#44; TPSB2&#44; TPSAB1&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                    0 => array:2 [
                      "titulo" => "Renal manifestations of tuberous sclerosis complex&#58; incidence&#44; prognosis&#44; and predictive factors"
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                          "etal" => false
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                            3 => "D&#46;J&#46;R&#46; Steele"
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                        "tituloSerie" => "Kidney Int"
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                        "volumen" => "70"
                        "paginaInicial" => "1777"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17003820"
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                      "titulo" => "Tuberous sclerosis&#46; vol&#46; 111"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Curatolo"
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                      "doi" => "10.1016/B978-0-444-52891-9.00038-5"
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                        "fecha" => "2013"
                        "editorial" => "Elsevier B&#46;V&#46;"
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              "etiqueta" => "3"
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                0 => array:1 [
                  "referenciaCompleta" => "Martignoni G&#44; Bonetti F&#44; Pea M&#44; Tardanico R&#44; Brunelli M&#44; Eble JN&#46; Renal disease in adults with TSC2&#47;PKD1 contiguous gene syndrome&#46; Am J Surg Pathol&#46; 2002&#59;26&#40;2&#41;&#58;198-205&#46; https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1097&#37;2F00000478-200202000-00006"
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                      "titulo" => "A large TSC2 and PKD1 gene deletion is associated with renal and extrarenal signs of autosomal dominant polycystic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Longa"
                            1 => "F&#46; Scolari"
                            2 => "A&#46; Brusco"
                            3 => "C&#46; Carbonara"
                            4 => "S&#46; Polidoro"
                            5 => "B&#46; Valzorio"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/12.9.1900"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transpl"
                        "fecha" => "1997"
                        "volumen" => "12"
                        "paginaInicial" => "1900"
                        "paginaFinal" => "1907"
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                          "pii" => "S0015028205014287"
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              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tuberous sclerosis complex with an unruptured intracranial aneurysm&#58; manifestations of contiguous gene syndrome"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46;L&#46; Chen"
                            1 => "C&#46;B&#46; Luo"
                            2 => "S&#46;W&#46; Hsu"
                            3 => "G&#46; Rodesch"
                            4 => "P&#46; Lasjaunias"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1177/159101990100700410"
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                        "tituloSerie" => "Interv Neuroradiol"
                        "fecha" => "2001"
                        "volumen" => "7"
                        "paginaInicial" => "337"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal cystic disease in tuberous sclerosis&#58; role of the polycystic kidney disease 1 gene"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;R&#46; Sampson"
                            1 => "M&#46;M&#46; Maheshwar"
                            2 => "R&#46; Aspinwall"
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                    0 => array:2 [
                      "doi" => "10.1086/514888"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Hum Genet"
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Case report
TSC2/PKD1 contiguous gene syndrome, with emphasis on a case with an atypical mild polycystic kidney phenotype and a novel genetic variant
Síndrome de genes contiguos TSC2/PKD1 con énfasis en un caso con un fenotipo atípico de riñón poliquístico leve y una nueva variante genética
Miriam E. Reyna-Fabiána, Miguel A. Alcántara-Ortigozaa, Nancy L. Hernández-Martíneza, Jaime Berumenb,c, Raquel Jiménez-Garcíad, Gilberto Gómez-Garzae, Ariadna González-del Angela,?
Corresponding author
ariadnagonzalezdelangel@gmail.com

Corresponding author at: Laboratorio de Biología Molecular, Departamento de Genética Humana, Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700-C, Insurgentes-Cuicuilco, Del. Coyoacán, CP 04530, Ciudad de México, México.
a Laboratorio de Biología Molecular, Departamento de Genética Humana, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
b Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
c Unidad de Medicina Genómica, Hospital General de México, Ciudad de México, México
d Servicio de Nefrología, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
e Resonancia Magnética, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Molecular PKDTS characterization in the three TSC patients&#46; &#40;A&#41; Schematic representation of the deletions detected by MLPA in the three PKDTS cases &#40;not drawn to scale&#41;&#46; Vertical gray lines in the <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> genes indicate exons with proportional spacing&#46; The long black lines above indicate the range of each heterozygous deletion&#46; A short dotted arrow and a question mark represent the expected minimal deletion interval estimated by MLPA&#46; &#40;B&#41; Schematic representation of the rearrangement detected in the 16p13&#46;3 region by CMA in case 3 &#40;not drawn to scale&#41;&#46; Gray lines at the right indicate deleted coding genes &#40;complete deletion of <span class="elsevierStyleItalic">TSC2</span> and deletion of exons 20&#8211;46 of <span class="elsevierStyleItalic">PKD1</span>&#41; and double gray lines at the left indicate the duplicated coding genes &#40;three copies&#41;&#44; including <span class="elsevierStyleItalic">SSTR5</span>&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; Cen&#58; centromeric region&#44; CMA&#58; chromosomal microarray analysis&#44; Ex&#58; exon&#44; MLPA&#58; multiplex ligation-dependent probe amplification&#44; Tel&#58; telomeric region&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberous sclerosis complex &#40;TSC&#44; MIM&#35;191100&#41; is an autosomal dominant disorder that is characterized by the development of multiple hamartomas and is caused by heterozygous pathogenic variants in the tumor suppressor genes&#44; <span class="elsevierStyleItalic">TSC1</span> or <span class="elsevierStyleItalic">TSC2</span>&#46; The most common renal lesions are angiomyolipomas&#44; occurring in &#62;80&#37; of the patients and frequently presented as multiple and bilateral&#46; Besides&#44; approximately 14&#8211;32&#37; of the TSC cases exhibit some degree of renal cyst formation&#44; most of which occurs in the second decade of life&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Early development of multiple renal cysts with kidney enlargement in TSC patients is associated with the heterozygous contiguous deletion of <span class="elsevierStyleItalic">TSC2</span> and the adjacent <span class="elsevierStyleItalic">PKD1</span> gene&#59; this last is the causative for autosomal dominant polycystic kidney disease &#40;ADPKD&#44; MIM&#35;173900&#41;&#46; The <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> contiguous gene syndrome &#40;PKDTS&#44; MIM &#35;600273&#41; reportedly comprises ~2&#8211;5&#37; of all TSC cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> These patients should be diagnosed as early as possible due to the <span class="elsevierStyleItalic">PKD1</span> deletion that increases the risk for ADPKD-related complications such as cystic kidney disease&#44; hepatic and pancreatic cysts&#44; arterial hypertension&#44; intracranial aneurysm<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;5</span></a> and to the probability of presenting an early end-stage renal disease &#40;20&#8211;30 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Molecular analysis is crucial for the early and confirmed diagnosis of PKDTS&#44; which allows clinicians to assess for the progressive renal lesions and other potentially fatal ADPKD-related complications&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> To date&#44; more than 65 molecularly characterized cases of PKDTS have been reported &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;8&#8211;16</span></a> However&#44; the precise deletion interval has only been identified in a few of these patients&#44; and no clear genotype&#8211;phenotype correlation has been established&#46; Hence&#44; we need to describe more PKDTS patients and their responsible genotypes in order to identify possible genotype&#8211;phenotype correlations and&#47;or the mechanisms underlying the phenotypic variability of PKDTS&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case presentation</span><p id="par0015" class="elsevierStylePara elsevierViewall">Herein we describe three unrelated Mexican pediatric patients who fulfilled the criteria of Northrup et al&#46; for a definitive diagnosis of TSC &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Written informed consent was obtained for all cases and the five available parents&#44; besides&#44; the study protocol was revised and approved by the local ethics committee &#40;reference number 060&#47;2014&#41;&#46; DNA samples were acquired from peripheral blood leukocytes by standard <span class="elsevierStyleItalic">in silica</span> adsorption method&#46; At the time of admission&#44; cases 1 and 2 revealed multiple bilateral renal cysts on ultrasonography &#40;US&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>A and B&#41;&#46; Since this suggested a classic PKDTS phenotype&#44; these cases were subjected to a multiplex ligation-dependent probe amplification &#40;MLPA&#41; assay &#40;SALSA MLPA&#174; P337 TSC2 probemix&#44; Lot 0510-A2&#59; MRC-Holland Amsterdam&#44; The Netherlands&#41; that included 39 probes for <span class="elsevierStyleItalic">TSC2</span> and one probe for <span class="elsevierStyleItalic">PKD1</span> &#40;exon 40&#41;&#46; The MLPA results revealed a deletion involving exons 31&#8211;42 from <span class="elsevierStyleItalic">TSC2</span> and at least exons 40&#8211;46 from <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>A&#41; in both cases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">For case 3&#44; a single cyst &#40;&#60;10<span class="elsevierStyleHsp" style=""></span>mm&#41; in the right kidney was identified by US at 4 years of age&#44; and follow-up US examinations yielded similar results &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>C&#41;&#46; It should be noted that the molecular protocol carried out in this case 3 started with a direct Sanger sequencing &#40;SS&#41; of all coding exons and the exon&#8211;intron boundaries of <span class="elsevierStyleItalic">TSC1</span> and <span class="elsevierStyleItalic">TSC2</span> since there was no clinical suspicious of PKDTS due to the presence of a single renal cyst&#46; As the SS results did not reveal any pathogenic variant a MLPA methodology was implemented and it revealed the presence of a large deletion that comprised all coding exons of <span class="elsevierStyleItalic">TSC2</span> and at least exons 40&#8211;46 of <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>A&#41;&#46; Based on this genotype&#44; a posteriori magnetic resonance imaging &#40;MRI&#41; was performed at age 15 to intentionally search for multiple renal cysts&#46; The MRI results exposed more than 25 small cysts of variable size &#40;9<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD 5&#46;39<span class="elsevierStyleHsp" style=""></span>mm&#41; in both kidneys &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>D&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To clarify the size and exact breakpoints of the deleted region in case 3&#44; we performed chromosomal microarray &#40;CMA&#41; analysis &#40;CytoScan&#8482; High Density Microarray&#59; Affymetrix&#44; Inc&#46;&#44; Santa Clara&#44; CA&#44; USA&#41; using the Human Genome Assembly hg38 for the analysis&#46; We detected a 230&#46;8<span class="elsevierStyleHsp" style=""></span>kb heterozygous deletion that encompassed 13 coding genes&#44; including all of <span class="elsevierStyleItalic">TSC2</span> and part of <span class="elsevierStyleItalic">PKD1</span> &#40;exons 20&#8211;46&#41;&#44; along with a neighboring heterozygous duplication of a previously undescribed CNV &#40;242&#46;9<span class="elsevierStyleHsp" style=""></span>kb&#41; in the 16p13&#46;3 region that included six coding genes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>B&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the time of last evaluation&#44; renal function was preserved in all three cases&#44; although cases 2 and 3 had elevated glomerular filtration rates&#44; and case 1 had microscopic hematuria without proteinuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; None of the three cases presented intracranial aneurysm &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; Both parents of all three patients had normal findings on clinical examination&#44; cerebral computed tomography and renal US&#44; while five had normal MLPA <span class="elsevierStyleItalic">TSC2</span> results&#46; Thus&#44; only two out of the three PKDTS cases identified herein were considered as <span class="elsevierStyleItalic">the novo</span> since DNA was not available for testing in the father of case 2&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The three studied cases displayed multiple renal cysts&#46; Cases 1 and 2 were consistent with a classic PKDTS phenotype&#58; large kidney cysts were identified by US at an early stage and predominated over angiomyolipomas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>A and B&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; These two cases appeared to exhibit the same partial heterozygous deletion of <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span>&#44; although the exact 5&#180; deletion breakpoint in <span class="elsevierStyleItalic">PKD1</span> was not identified by the employed MLPA assay &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>A&#41;&#46; To date&#44; 30 PKDTS cases have been described in which the contiguous deletion affects parts of <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#46; In general&#44; regardless of the extent of the deletion&#44; the renal cysts were larger and the renal function fell below normal at a younger age than seen in typical TSC cases without any <span class="elsevierStyleItalic">PKD1</span> deletion&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Unexpectedly&#44; case 3 exhibited small cysts that could only be detected by MRI&#44; which is better able to detect small cysts &#40;&#60;1<span class="elsevierStyleHsp" style=""></span>cm&#41; in ADPKD patients compared to US&#44; although the latter is the initial test of choice in the polycystic kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">To date&#44; at least 25 other PKDTS cases have been reported to include deletion of genes in addition to <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#59; among them&#44; our case 3 appears to harbor the largest deletion upstream of <span class="elsevierStyleItalic">TSC2</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>B&#41;&#46; In three of the previously reported cases&#44; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41; the early PKD symptoms and end-stage renal disease were recognized fairly late &#40;&#62;20 years&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;11&#44;12</span></a> This is similar to case 3&#44; in which only a few small cysts were found at age 15 and renal function was preserved &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46; The previous authors speculated that the relatively mild kidney involvement could reflect somatic mosaicism or the presence of genetic modifiers&#44; but these hypotheses were not tested&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Other studies have suggested that a mild PKD phenotype &#40;better preserved renal function&#44; as evaluated by glomerular filtration rate&#44; and cystic disease recognized only in adult life&#41; is associated with low&#47;high grade deletion mosaicism&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10&#44;11</span></a> However&#44; the apparently mild PKD phenotype in case 3 could not be explained by somatic mosaicism&#44; as the MLPA results showed that the ratio values &#40;STD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;10&#41; for each probe involved in the <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> contiguous deletion were reduced by 0&#46;5&#44; implying that 100&#37; of the peripheral leukocyte cells were heterozygous for this genotype and in addition&#44; we detected a smooth signal of 1&#46;2 copies &#40;heterozygous deletion genotype&#41; in CMA data&#46; However&#44; a low-level mosaicism could not be totally ruled out by CMA data since the deletion size is very small and the CytoScan<span class="elsevierStyleSup">TM</span> algorithm is designed to discard mosaicism by the analysis of at least 5000 markers in deleted region&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The variable progression of PKD in our patients and the reported cases plus the absence of a clear genotype&#8211;phenotype correlation suggest that the mechanisms underlying renal cyst formation in PKD are extremely complex and may involve environmental and&#47;or genetic factors that are not solely related to the <span class="elsevierStyleItalic">PKD</span> genotype&#46; The identified 296&#46;7<span class="elsevierStyleHsp" style=""></span>kb CNV in the 16p13&#46;3 region of case 3&#44; which had not been previously reported as pathogenic in Decipher<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> or the Database of Genomic Variants&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> included six coding genes and remarkable among them is the <span class="elsevierStyleItalic">SSTR5</span> &#40;somatostatin receptor&#41; gene&#46; Although&#44; small clinical trials showed that somatostatin analogs &#40;SSAs&#41; decreased total kidney volume in patients with ADPKD&#44; larger trials are ongoing to know their final effect in kidney cysts&#44; so at this time&#44; they are only indicated in ADPKD patients with severe liver cystic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#8211;25</span></a> The precise mechanism through which SSAs &#40;e&#46;g&#46;&#44; lanreotide and octreotide&#41; inhibit cystogenesis is not fully understood&#44; but SSAs can inhibit cAMP accumulation&#44; which plays a crucial role in cystogenesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a> We hypothesize that the triple gene dosage of <span class="elsevierStyleItalic">SSTR5</span> correlates with increased binding of the receptor&#39;s ligand&#44; which would further reduce intracellular cAMP levels and decrease cellular proliferation through the Ras&#47;Raf&#47;MEK&#47;ERK pathways&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Modifier genes have previously been proposed to be present within CNVs of monogenic disorders&#46; For example&#44; Artuso et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> detected a CNV containing a candidate modifier gene for Rett syndrome &#40;MIM&#35;312750&#41;&#46; In two sisters with the same pathogenic genotype of <span class="elsevierStyleItalic">MECP2</span> &#40;the gene responsible for Rett syndrome&#41;&#44; the three copies of <span class="elsevierStyleItalic">CROCC</span> &#40;1p36&#46;13&#41; was associated with a milder phenotype&#44; while a single gene copy was associated with the classic phenotype of Rett syndrome&#46; Thus&#44; it can be hypothesized that the presence of the CNV with the three <span class="elsevierStyleItalic">SSTR5</span> copies in our case 3 may counteract the <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> deletion and modulate the PKD severity&#46; However&#44; future work is warranted to examine this possibility&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the other hand&#44; we can neither rule out that in case 3 the heterozygous loss of any of the 13 coding genes&#44; others than <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span>&#44; could act as disease modifier&#46; In fact&#44; it has been shown that some of these genes are expressed in the kidney&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> although none has been involved in a syndrome associating with kidney alterations in OMIM&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0060" class="elsevierStylePara elsevierViewall">The cystic phenotype in PKDTS cases varies considerable among individuals&#59; this suggests that a combination of factors besides the <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> genotype&#44; as modifying genes could be implied in the progression of the disease&#46; Given the reported effect of SSAs in cystogenesis and the presence of three copies of <span class="elsevierStyleItalic">SSTR5</span> in the patient who exhibited the mildest PKD phenotype &#40;case 3&#41; we hypothesize that an increased gene dosage of <span class="elsevierStyleItalic">SSTR5</span> could counteract the PKD phenotype and its progression&#46; The main limitation of our work relies on the fact that the exact 5&#39;<span class="elsevierStyleItalic">PKD1</span> breakpoint in cases 1 and 2 could not be determined&#44; however&#44; these two cases presented multiple cysts in both kidneys at early age as expected with a classic PKDTS&#46; Considering that no previous studies have reported possible modifier genetic variants in other PKDTS patients&#44; future work that includes functional analyses&#44; frequency population studies in healthy individuals and more PKDTS cases will be necessary to determine the role of the 16p13&#46;3 CNV&#44; that contains <span class="elsevierStyleItalic">SSTR5</span> in case 3 which apparently harbors the largest <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> deletion and the mildest PKDTS phenotype&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study was supported by the research funding from the National Institute of Pediatrics&#44; Ciudad de M&#233;xico&#44; M&#233;xico &#40;Recursos Fiscales del Programa E022&#41;&#44; as well as funding from Consejo Nacional de Ciencia y Tecnolog&#237;a&#44; M&#233;xico &#40;CONACyT FONSEC SSA&#47;IMSS&#47;ISSSTE&#44; S0008&#44; 2016&#8211;2018&#44; Project &#35;261404&#41;&#44; Fundaci&#243;n &#8220;Miguel Alem&#225;n&#8221; 2012 and Novartis &#40;2013&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interests&#46;</p></span></span>"
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              "identificador" => "abst0005"
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        1 => array:2 [
          "identificador" => "xpalclavsec1216597"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "xpalclavsec1216595"
          "titulo" => "Abbreviations"
        ]
        3 => array:3 [
          "identificador" => "xres1318559"
          "titulo" => "Resumen"
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        4 => array:2 [
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          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "xpalclavsec1216596"
          "titulo" => "Abreviaturas"
        ]
        6 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        7 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case presentation"
        ]
        8 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
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        9 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
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        10 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Funding"
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          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
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        12 => array:2 [
          "identificador" => "xack454579"
          "titulo" => "Acknowledgements"
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        13 => array:1 [
          "titulo" => "References"
        ]
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-08-10"
    "fechaAceptado" => "2019-03-26"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1216597"
          "palabras" => array:5 [
            0 => "Tuberous sclerosis complex"
            1 => "Polycystic kidney disease"
            2 => "Copy number variant"
            3 => "<span class="elsevierStyleItalic">TSC2</span>&#47;<span class="elsevierStyleItalic">PKD1</span> contiguous gene syndrome"
            4 => "<span class="elsevierStyleItalic">SSTR5</span> gene"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1216595"
          "palabras" => array:8 [
            0 => "ADPKD"
            1 => "CNV"
            2 => "CMA"
            3 => "MLPA"
            4 => "PKD"
            5 => "PKDTS"
            6 => "SSAs"
            7 => "TSC"
          ]
        ]
      ]
      "es" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1216594"
          "palabras" => array:5 [
            0 => "Complejo de esclerosis tuberosa"
            1 => "Enfermedad del ri&#241;&#243;n poliqu&#237;stico"
            2 => "Variante del n&#250;mero de copias"
            3 => "S&#237;ndrome de genes contiguos <span class="elsevierStyleItalic">TSC2</span>&#47;<span class="elsevierStyleItalic">PKD1</span>"
            4 => "Gen <span class="elsevierStyleItalic">SSTR5</span>"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abreviaturas"
          "identificador" => "xpalclavsec1216596"
          "palabras" => array:3 [
            0 => "CET"
            1 => "ERP"
            2 => "PKDTS"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">About 80&#37; of patients with tuberous sclerosis complex &#40;TSC&#41; present renal involvement&#44; usually as angiomyolipomas followed by cystic disease&#46; An early diagnosis of polycystic kidney disease &#40;PKD&#41; in such patients is frequently related to the <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> contiguous gene syndrome &#40;PKDTS&#41;&#46; Molecular confirmation of PKDTS is important for a prompt diagnosis&#44; which can be complicated by the phenotypic heterogeneity of PKD and the absence of a clear phenotype&#8211;genotype correlation&#46; Herein&#44; we report three PKDTS pediatric patients&#46; The case 3 did not present a classic PKDTS phenotype&#44; having only one observable cyst on renal ultrasound at age 4 and multiple small cysts on magnetic resonance imaging at age 15&#46; In this patient&#44; chromosomal microarray analysis showed a gross deletion of 230&#46;8<span class="elsevierStyleHsp" style=""></span>kb that involved <span class="elsevierStyleItalic">TSC2</span>&#44; <span class="elsevierStyleItalic">PKD1</span> and 13 other protein-coding genes&#44; plus a heterozygous duplication of a previously undescribed copy number variant of 242&#46;9<span class="elsevierStyleHsp" style=""></span>kb that involved six protein-coding genes&#44; including <span class="elsevierStyleItalic">SSTR5</span>&#44; in the 16p13&#46;3 region&#46; Given the observations that the case 3 presented the mildest renal phenotype&#44; harbored three copies of <span class="elsevierStyleItalic">SSTR5&#44;</span> and the reported inhibition of cystogenesis &#40;specially in liver&#41; observed with somatostatin analogs in some patients with autosomal dominant PKD&#44; it can be hypothesized that other genetic factors as the gene dosage of <span class="elsevierStyleItalic">SSTR5</span> may influence the PKD phenotype and the progression of the disease&#59; however&#44; future work is needed to examine this possibility&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un 80&#37; de los pacientes con complejo de esclerosis tuberosa &#40;CET&#41; presentan afectaci&#243;n renal&#44; generalmente angiomiolipomas&#44; seguidos de enfermedad qu&#237;stica&#46; Un diagn&#243;stico temprano de la enfermedad renal poliqu&#237;stica &#40;ERP&#41; en estos pacientes se relaciona con frecuencia con el s&#237;ndrome de genes contiguos <span class="elsevierStyleItalic">TSC2&#47;PKD1</span> &#40;PKDTS&#41;&#46; La confirmaci&#243;n molecular de PKDTS es importante para establecer un diagn&#243;stico oportuno&#44; que puede complicarse por la heterogeneidad fenot&#237;pica de PKD y la ausencia de una clara correlaci&#243;n entre fenotipo y genotipo&#46; En este art&#237;culo presentamos los casos de 3 pacientes pedi&#225;tricos con PKDTS&#46; El caso 3 no present&#243; un fenotipo PKDTS cl&#225;sico&#44; con solo un quiste observable en la ecograf&#237;a renal a los 4 a&#241;os y numerosos quistes peque&#241;os en la resonancia magn&#233;tica a los 15 a&#241;os&#46; En este paciente&#44; el an&#225;lisis de microarreglos para an&#225;lisis cromos&#243;mico global mostr&#243; una eliminaci&#243;n total de 230&#44;8<span class="elsevierStyleHsp" style=""></span>kb que involucr&#243; a <span class="elsevierStyleItalic">TSC2&#44;</span><span class="elsevierStyleItalic">PKD1</span> y otros 13 genes codificantes de prote&#237;nas&#44; m&#225;s una duplicaci&#243;n heterocigota para una variante de n&#250;mero de copias no descrita previamente de 242&#44;9<span class="elsevierStyleHsp" style=""></span>kb que involucr&#243; a 6 genes codificantes de prote&#237;nas&#44; entre ellos <span class="elsevierStyleItalic">SSTR5&#44;</span> en la regi&#243;n 16p13&#46;3&#46; Dado que el caso 3 mostraba el fenotipo renal menos severo&#44; contaba con tres copias del gen <span class="elsevierStyleItalic">SSTR5</span> y a que se ha observado una inhibici&#243;n en la cistog&#233;nesis &#40;especialmente en el h&#237;gado&#41; con los an&#225;logos de somatostatina en algunos pacientes con ERP autos&#243;mica dominante&#44; podemos hipotetizar que existen otros factores gen&#233;ticos como la dosis g&#233;nica de <span class="elsevierStyleItalic">SSTR5</span> que pudieran influir en el fenotipo y la progresi&#243;n de la ERP&#59; sin embargo&#44; se necesitan estudios adicionales para investigar esta posibilidad&#46;</p></span>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">TS</span>C2 and <span class="elsevierStyleItalic">PKD1</span> deletions characterized by various molecular techniques in the reported PKDTS cases&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="202003180710049251"></elsevierMultimedia>&#44; Complete deletion of the gene&#59; <elsevierMultimedia ident="202003180710049252"></elsevierMultimedia>&#44; partial deletion of the gene&#59; &#63;&#44; Unknown breakpoint&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; aCGH&#58; microarray-based comparative genomic hybridization&#59; CMA&#58; chromosomal microarray&#59; FISH&#58; fluorescence <span class="elsevierStyleItalic">in situ</span> hybridization&#59; MLPA&#58; multiplex ligation-dependent probe amplification&#59; qPCR&#58; quantitative PCR&#44; &#42;Cases in which PKD symptoms and end-stage renal disease were recognized fairly late &#40;&#62;20 years&#41;&#46;</p>"
        ]
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        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Renal image studies in the three TSC patients&#46; &#40;A and B&#41; Polycystic kidney disease detected by US in cases 1 and 2&#46; &#40;C&#41; Single cyst in the right kidney detected by US in case 3 &#40;arrows&#41;&#46; &#40;D&#41; Polycystic kidney disease detected by MRI in case 3&#46;</p>"
        ]
      ]
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        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Molecular PKDTS characterization in the three TSC patients&#46; &#40;A&#41; Schematic representation of the deletions detected by MLPA in the three PKDTS cases &#40;not drawn to scale&#41;&#46; Vertical gray lines in the <span class="elsevierStyleItalic">TSC2</span> and <span class="elsevierStyleItalic">PKD1</span> genes indicate exons with proportional spacing&#46; The long black lines above indicate the range of each heterozygous deletion&#46; A short dotted arrow and a question mark represent the expected minimal deletion interval estimated by MLPA&#46; &#40;B&#41; Schematic representation of the rearrangement detected in the 16p13&#46;3 region by CMA in case 3 &#40;not drawn to scale&#41;&#46; Gray lines at the right indicate deleted coding genes &#40;complete deletion of <span class="elsevierStyleItalic">TSC2</span> and deletion of exons 20&#8211;46 of <span class="elsevierStyleItalic">PKD1</span>&#41; and double gray lines at the left indicate the duplicated coding genes &#40;three copies&#41;&#44; including <span class="elsevierStyleItalic">SSTR5</span>&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; Cen&#58; centromeric region&#44; CMA&#58; chromosomal microarray analysis&#44; Ex&#58; exon&#44; MLPA&#58; multiplex ligation-dependent probe amplification&#44; Tel&#58; telomeric region&#46;</p>"
        ]
      ]
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">All cases are definitive according to the criteria of Northrup et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Seizures are well controlled in all three cases&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CMA&#58; chromosomal microarray&#59; eGFR&#58; estimated glomerular filtration rate&#59; m&#58; months&#59; MLPA&#58; multiple ligation probe amplification&#59; NA&#58; not analyzed&#59; y&#58; years&#59; &#43;&#58; present&#59; -&#58; absent&#46;</p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age at hospital admission&#47;PKD diagnosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Current age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18y&#44; 5m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18y&#44; 9m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15y&#44; 8m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC major features</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypomelanotic macules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angiofibromas &#40;&#61;3&#41; or fibrous cephalic plaque&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ungual fibromas &#40;&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Shagreen patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple retinal hamartomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cortical dysplasias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subependymal nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subependymal giant cell astrocytoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac rhabdomyoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphangioleiomyomatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angiomyolipomas &#40;&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC minor features</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Confetti skin lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dental enamel pits &#40;&#62;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intraoral fibromas &#40;&#61;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retinal achromic patch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple renal cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nonrenal hamartomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Other clinical findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Seizures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intellectual disability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Central nervous system alterations&#44; aneurysms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 16y&#44; 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 15y&#44; 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 11y&#44; 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Liver cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 14y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 18y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent at 13y&#44; 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kidney findings at last evaluation age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16y&#44; 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10y&#44; 9m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13y&#44; 2m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>eGFR<a class="elsevierStyleCrossRef" href="#tblfn0020">&#42;</a> &#40;normal 90&#8211;120<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Blood pressure &#40;systolic&#47;diastolic PC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hemoglobin &#40;12&#8211;15</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Uric acid &#40;2&#46;4&#8211;5&#46;9</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Proteinuria &#40;urinary protein to creatinine ratio</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">0&#46;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematuria &#40;2&#8211;5 RBCs&#47;high power field&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;positive&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not measured&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#37; Kidney growth per year</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Molecular studies</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Deleted region by MLPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC2</span> &#40;Exons 31&#8211;42&#41;&#44; <span class="elsevierStyleItalic">PKD1</span> &#40;Exons 46&#8211;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC2</span> &#40;Exons 31&#8211;42&#41;&#44; <span class="elsevierStyleItalic">PKD1</span> &#40;Exons 46&#8211;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TSC2</span> &#40;whole gene deletion&#41;&#44; <span class="elsevierStyleItalic">PKD1</span> &#40;Exons 20&#8211;46&#41;&#44; exact breakpoint further delineated by CMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Deleted region by CMA&#47;deleted genes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">We thank Dr&#46; Lorena Lechuga Becerra&#44; MD&#44; for participating in the initial medical assessment of the patients&#46; This study makes use of data generated by the DECIPHER community&#46; A full list of centers that contributed to the generation of the data is available from <a target="_blank" href="http://decipher.sanger.ac.uk/">http&#58;&#47;&#47;decipher&#46;sanger&#46;ac&#46;uk</a> and via email from <a target="_blank" href="http://www.decipher.sanger.ac.uk/">www&#46;decipher&#46;sanger&#46;ac&#46;uk</a>&#46;</p>"
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Nefrología (English Edition)