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Nail-patella syndrome (NPS) (also known as “Fong syndrome,” and “Hereditary osteoonychodysplasia”[1]) is a genetic disorder that is also referred to as Iliac Horn Syndrome, Hereditary Onychoostedysplasia, Fong Disease or Turner-Kiser Syndrome.

Nail-patella syndrome is inherited in an autosomal dominant pattern.The Nail-Patella syndrome is inherited via autosomal dominancy (see autosomal dominant) linked to aberrancy on human chromosome 9’s q arm (q stands for longer arm), 9q34. This autosomal dominancy means that only a single copy, instead of both, is sufficient for disorder to be expressed in the offspring, meaning that the chance of getting the disorder from an affected parent is 50%. The frequency of the occurrence is 1/50,000. The disorder is linked to the ABO blood group locus.

The hallmark features of this syndrome are poorly developed fingernails, toenails, and patellae (kneecaps). Sometimes, this disease causes the affected person to have either no thumbnails or a small piece of a thumbnail on the edge of the thumb. Other common abnormalities include elbow deformities, abnormally shaped pelvis bone (hip bone), and kidney (renal) disease. Also, some research shows that people with NPS are more prone to glaucoma and scoliosis, due to poorly developed spines.

People with nail-patella syndrome may display only a few or many of the recognized signs of this disease. Symptoms vary widely from person to person. Signs even vary within a single family with multiple affected members.

Treatment

Medical Care
Unless the patient presents with acute findings, perform the evaluation on an outpatient basis.
Suggest knee replacement if the patient develops osteoarthritis in the knees.
Dialysis and transplantation are necessary in patients who develop ESRD. Approximately 30-55% of patients have renal involvement.
The use of diuretics in patients with nephrotic syndrome depends on the glomerular filtration rate. Any therapy for edema requires an assessment of intravascular volume status.
Surgical Care
Renal transplantation has proven successful in patients with nail-patella syndrome (NPS) who develop ESRD.
Avoid excision of the radial head to correct elbow arthrodysplasia. This excision forces the ulna into the wrist, creating a painful condition.
MRI is necessary to reveal the abnormal muscle and nerve insertions that may complicate orthopedic procedures.
Consultations
Dentist
Geneticist
Nephrologist
Ophthalmologist
Orthopedist
Rheumatologist
Diet
No dietary restrictions are necessary unless hypertension or nephrotic syndrome develop. At this time, a salt-free diet is appropriate.
Activity
Joint abnormalities generally do not limit physical activity.

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