O Raquitismo Hipofosfatêmico Autossômico Recessivo (ARHR) é uma condição de saúde hereditária (transmitida geneticamente pelos pais) em que os rins perdem fosfato em excesso. Essa doença é caracterizada por níveis baixos de fosfato no sangue, raquitismo (em crianças) e/ou osteomalacia (em adultos), que são problemas que enfraquecem os ossos, e por um crescimento mais lento.
Introdução
O que você precisa saber de cara
O Raquitismo Hipofosfatêmico Autossômico Recessivo (ARHR) é uma condição de saúde hereditária (transmitida geneticamente pelos pais) em que os rins perdem fosfato em excesso. Essa doença é caracterizada por níveis baixos de fosfato no sangue, raquitismo (em crianças) e/ou osteomalacia (em adultos), que são problemas que enfraquecem os ossos, e por um crescimento mais lento.
Escala de raridade
<1/50kMuito rara
1/20kRara
1/10kPouco freq.
1/5kIncomum
1/2k
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Entender a doença
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Sinais e sintomas
O que aparece no corpo e com que frequência cada sintoma acontece
Partes do corpo afetadas
+ 17 sintomas em outras categorias
Características mais comuns
Os sintomas variam de pessoa para pessoa. Abaixo estão as 47 características clínicas mais associadas, ordenadas por frequência.
Linha do tempo da pesquisa
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Genética e causas
O que está alterado no DNA e como passa nas famílias
Genes associados
2 genes identificados com associação a esta condição. Padrão de herança: Autosomal recessive.
Nucleotide pyrophosphatase that generates diphosphate (PPi) and functions in bone mineralization and soft tissue calcification by regulating pyrophosphate levels (By similarity). PPi inhibits bone mineralization and soft tissue calcification by binding to nascent hydroxyapatite crystals, thereby preventing further growth of these crystals (PubMed:11004006). Preferentially hydrolyzes ATP, but can also hydrolyze other nucleoside 5' triphosphates such as GTP, CTP and UTP to their corresponding mono
Cell membraneBasolateral cell membraneSecreted
Ossification of the posterior longitudinal ligament of the spine
A calcification of the posterior longitudinal ligament of the spinal column, usually at the level of the cervical spine. Patients with OPLL frequently present with a severe myelopathy that can lead to tetraparesis.
Transcriptional activator which activates the CDKN2A/ARF locus in response to Ras-Raf signaling, thereby promoting p53/TP53-dependent growth arrest (By similarity). Binds to the consensus sequence 5'-CCCG[GT]ATGT-3' (By similarity). Isoform 1 may cooperate with MYB to activate transcription of the ANPEP gene. Isoform 2 may antagonize transcriptional activation by isoform 1
Nucleus
Medicamentos aprovados (FDA)
1 medicamento encontrado nos registros da FDA americana.
Variantes genéticas (ClinVar)
191 variantes patogênicas registradas no ClinVar.
Vias biológicas (Reactome)
7 vias biológicas associadas aos genes desta condição.
Diagnóstico
Os sinais que médicos procuram e os exames que confirmam
Tratamento e manejo
Remédios, cuidados de apoio e o que precisa acompanhar
Onde tratar no SUS
Hospitais de referência no Brasil e o protocolo oficial do SUS (PCDT)
🇧🇷 Atendimento SUS — Raquitismo hipofosfatêmico autossômico recessivo
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Dados de DATASUS/CNES, SBGM, ABNeuro e Ministério da Saúde. Sempre confirme a disponibilidade diretamente com o estabelecimento.
Pesquisa ativa
Ensaios clínicos abertos e novidades científicas recentes
Ensaios em destaque
🟢 Recrutando agora
3 pesquisas recrutando participantes. Converse com seu médico sobre a possibilidade de participar.
Outros ensaios clínicos
11 ensaios clínicos encontrados, 4 ativos.
Publicações mais relevantes
Phenotypic Diversity in Autosomal Recessive Hypophosphatemic Rickets Type 2.
Autosomal Recessive Hypophosphatemic Rickets Type 2 (ARHR2) caused by biallelic ENPP1 mutations is a rare disorder with a broad phenotypic spectrum. We describe three affected siblings from a consanguineous family who presented with markedly heterogeneous clinical features. The proband exhibited classical signs of rickets with progressive lower-limb deformities, short stature, and elevated alkaline phosphatase. Her older sister demonstrated limited elbow extension, conductive hearing loss, and vascular stenoses, while the youngest sibling developed early biochemical abnormalities before overt skeletal manifestations of rickets emerged. All affected children had hypophosphatemia, reduced TmP/GFR, and elevated or inappropriately normal FGF23 concentrations, consistent with FGF23-mediated phosphate wasting. Notably, plasma inorganic pyrophosphate (PPi) levels were markedly reduced in the affected children and mildly reduced in the carriers of monoallelic mutation. Genetic testing identified a homozygous ENPP1 variant, c.2559_2561del p.(Leu854del), which was essential for establishing the diagnosis and distinguishing ARHR2 from other hereditary forms of hypophosphatemic rickets. The father had low lumbar spine bone mineral density. These cases highlight the clinical heterogeneity of ENPP1 deficiency and reinforce the essential role of genetic testing in establishing the correct diagnosis.
Autosomal recessive hypophosphatemic rickets type 2 (ARHR2): Is phosphate supplementation safe?
Autosomal recessive hypophosphatemic rickets type 2 (ARHR2) is an ultra-rare disorder characterized by renal phosphate wasting and patients may exhibit an increased risk of vascular calcification. Phosphate supplementation, a standard treatment for hypophosphatemic rickets, may further increase this risk by elevating the calcium-phosphate product. To expand the phenotypic spectrum of ARHR2 and heterozygous ENPP1 variant carriers and to review safety concerns related to phosphate supplementation in affected individuals. We describe an 11-year follow-up of a pediatric patient with ARHR2, focusing on skeletal and extraskeletal manifestations, particularly the response to a brief period of phosphate supplementation. Additionally, we present a phenotypic analysis of four heterozygous family members, highlighting potential implications of carrier status. The patient was homozygous for the ENPP1 variant c.2677G > T, p.(Glu893*), exhibited progressive skeletal symptoms, and developed vascular calcifications following phosphate supplementation. Heterozygous family members showed mild alterations in bone and phosphate metabolism, suggesting a possible subclinical phenotype. This case highlights the complexity of ARHR2 management, the importance of accurate genetic diagnosis, and concerns regarding the safety of phosphate supplementation. Close cardiovascular monitoring is essential, and future therapies should aim to correct phosphate imbalance without increasing calcification risk-potentially through combined treatment strategies or enzyme replacement therapy.
Expanding the Autosomal Recessive Hypophosphatemic Rickets Type I Carrier Phenotype and Adult Treatment with Burosumab.
Optimizing diagnosis and management of patients with ENPP1 deficiency: an expert opinion.
Pediatric ABCC6 deficiency: a genotypic and phenotypic analysis.
ABCC6 deficiency is caused by variants in the ABCC6 gene, leading to dysfunction of the ABCC6 protein. This can result in the development of the infantile phenotype, generalized arterial calcification of infancy type 2 (GACI2), or the adolescent-adult phenotype, pseudoxanthoma elasticum (PXE). To date, the impact of ABCC6 deficiency in a pediatric population has not been comprehensively studied. This analysis aimed to collectively characterize the genotypic and phenotypic presentation of ABCC6 deficiency in the pediatric population. A literature review and analysis identified 95 individuals with ABCC6 variant(s) and documented clinical manifestations occurring from ages 0 to < 18 years. Of the 133 ABCC6 variants found, 57.1% were pathogenic, 26.3% were likely pathogenic, and 10.5% were of uncertain significance. A high prevalence of ectopic calcification with cardiovascular, dermatologic, neurologic, and ocular complications was observed across this pediatric ABCC6 deficiency cohort. While 56% were diagnosed with GACI and 44% with PXE, many individuals exhibited overlapping features of both conditions. There was a relatively high frequency of clinical manifestations through 6 years of age with lower frequency from ages 7 to 18 years. There was significant phenotypic variability observed across patients harboring the same ABCC6 variant(s). These findings demonstrate the wide spectrum and early emergence of cardiovascular, neurologic, and ocular complications in pediatric patients with ABCC6 deficiency. Given the variability of clinical presentations and absence of systematic phenotype characterization, pediatric ABCC6 deficiency is likely underdiagnosed. Establishing guidelines for assessment, genetic diagnosis, monitoring, and prognostic counseling would assist in the timely diagnosis and multidisciplinary management of pediatric patients with ABCC6 deficiency. The online version contains supplementary material available at 10.1186/s13023-025-04102-7.
Publicações recentes
Expanding the Autosomal Recessive Hypophosphatemic Rickets Type I Carrier Phenotype and Adult Treatment with Burosumab.
Optimizing diagnosis and management of patients with ENPP1 deficiency: an expert opinion.
Phenotypic Diversity in Autosomal Recessive Hypophosphatemic Rickets Type 2.
Six cases of ENPP1 pathogenic variants causing autosomal recessive hypophosphatemic rickets type 2 and generalized arterial calcification of infancy.
A case and review of fibroblast growth factor-23-mediated hypophosphatemic osteomalacia in the absence of pathogenic PHEX variants.
📚 EuropePMC26 artigos no totalmostrando 55
Expanding the Autosomal Recessive Hypophosphatemic Rickets Type I Carrier Phenotype and Adult Treatment with Burosumab.
Calcified tissue internationalOptimizing diagnosis and management of patients with ENPP1 deficiency: an expert opinion.
Journal of endocrinological investigationPhenotypic Diversity in Autosomal Recessive Hypophosphatemic Rickets Type 2.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchSix cases of ENPP1 pathogenic variants causing autosomal recessive hypophosphatemic rickets type 2 and generalized arterial calcification of infancy.
JBMR plusA case and review of fibroblast growth factor-23-mediated hypophosphatemic osteomalacia in the absence of pathogenic PHEX variants.
JBMR plusPediatric ABCC6 deficiency: a genotypic and phenotypic analysis.
Orphanet journal of rare diseasesThe prevalence of ENPP1 deficiency in humans with OPLL and the preclinical efficacy of ENPP1 enzyme therapy in OPLL mice.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchAutosomal recessive hypophosphatemic rickets type 2 (ARHR2): Is phosphate supplementation safe?
BoneImprovements in hearing loss with bone-targeted enzyme replacement therapy are associated with corrected hypomineralization and osteocyte properties of auditory ossicles in Enpp1-deficient mice.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchThe impact of monoallelic inactivation mutations in the ENPP1 gene on pediatric skeletal development: a case report and literature review.
Frontiers in endocrinologyPhenotypic characterization of ENPP1 deficiency: generalized arterial calcification of infancy and autosomal recessive hypophosphatemic rickets type 2.
JBMR plusBase of Skull & Spinal Canal Narrowing in an Adolescent with Autosomal Recessive Hypophosphatemic Rickets Type 2.
Calcified tissue internationalClinical presentation and burden of ENPP1 deficiency in adults.
Archives de pediatrie : organe officiel de la Societe francaise de pediatrieAutosomal recessive hypophosphatemic rickets type 2 due to ENPP1 deficiency (ARHR2).
Archives de pediatrie : organe officiel de la Societe francaise de pediatrieCommentary on: The use of burosumab to treat autosomal-recessive hypophosphatemic rickets type 2: rationale and a first clinical experience.
Journal of nephrologyAutosomal Recessive Hypophosphatemic Rickets Type 2 Associated with a Novel ENPP1 Variant in a Taiwanese Girl.
Journal of clinical research in pediatric endocrinologyLessons learned from the real-world diagnosis and management of hereditary hypophosphatemic rickets.
Bone reportsThe use of burosumab to treat autosomal-recessive hypophosphatemic rickets type 2: rationale and a first clinical experience.
Journal of nephrologyFGF23 directly inhibits osteoprogenitor differentiation in Dmp1-knockout mice.
JCI insightENPP1 in Blood and Bone: Skeletal and Soft Tissue Diseases Induced by ENPP1 Deficiency.
Annual review of pathologyGenetics of Diffuse Idiopathic Skeletal Hyperostosis and Ossification of the Spinal Ligaments.
Current osteoporosis reportsCase report: Multiple arterial stenoses induced by autosomal-recessive hypophosphatemic rickets type 2 associated with mutation of ENPP1: a case study.
Frontiers in cardiovascular medicineEffects of food, fasting, and exercise on plasma pyrophosphate levels and ENPP1 activity in healthy adults.
BoneEstimation of ENPP1 deficiency genetic prevalence using a comprehensive literature review and population databases.
Orphanet journal of rare diseasesThe First Compound Heterozygous Mutations of DMP1 Causing Rare Autosomal Recessive Hypophosphatemic Rickets Type 1.
The Journal of clinical endocrinology and metabolismFirst report in Argentina of a pathogenic DMP1 variant associated with autosomal recessive hypophosphatemic rickets.
Archivos argentinos de pediatriaOsteocytes and the pathogenesis of hypophosphatemic rickets.
Frontiers in endocrinologyPhosphatonins: From Discovery to Therapeutics.
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical EndocrinologistsENPP1 deficiency: A clinical update on the relevance of individual variants using a locus-specific patient database.
Human mutationCase Report and Review of Literature: Autosomal Recessive Hypophosphatemic Rickets Type 2 Caused by a Pathogenic Variant in ENPP1 Gene.
Frontiers in endocrinologyAutosomal recessive hypophosphatemic rickets type 2; a novel mutation in the ENPP1 gene.
The Turkish journal of pediatricsBurosumab Treatment for Autosomal Recessive Hypophosphatemic Rickets Type 1 (ARHR1).
The Journal of clinical endocrinology and metabolismMutation update: Variants of the ENPP1 gene in pathologic calcification, hypophosphatemic rickets, and cutaneous hypopigmentation with punctate keratoderma.
Human mutationIdentification of ENPP1 Haploinsufficiency in Patients With Diffuse Idiopathic Skeletal Hyperostosis and Early-Onset Osteoporosis.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchA Reference Range for Plasma Levels of Inorganic Pyrophosphate in Children Using the ATP Sulfurylase Method.
The Journal of clinical endocrinology and metabolismEctopic Calcification and Hypophosphatemic Rickets: Natural History of ENPP1 and ABCC6 Deficiencies.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchAutosomal recessive hypophosphatemic rickets type 2 (ARHR2) due to ENPP1-deficiency.
BoneINZ-701 Prevents Ectopic Tissue Calcification and Restores Bone Architecture and Growth in ENPP1-Deficient Mice.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchProspective phenotyping of long-term survivors of generalized arterial calcification of infancy (GACI).
Genetics in medicine : official journal of the American College of Medical GeneticsGenetic pathways disrupted by ENPP1 deficiency provide insight into mechanisms of osteoporosis, osteomalacia, and paradoxical mineralization.
BoneClinical Characteristics and Bone Features of Autosomal Recessive Hypophosphatemic Rickets Type 1 in Three Chinese Families: Report of Five Chinese Cases and Review of the Literature.
Calcified tissue internationalNew Therapies for Hypophosphatemia-Related to FGF23 Excess.
Calcified tissue internationalGeneralized Arterial Calcification of Infancy: New Insights, Controversies, and Approach to Management.
Current osteoporosis reportsHypophosphatemic osteosclerosis, hyperostosis, and enthesopathy associated with novel homozygous mutations of DMP1 encoding dentin matrix protein 1 and SPP1 encoding osteopontin: The first digenic SIBLING protein osteopathy?
BoneClinical and Biochemical Phenotypes in a Family With ENPP1 Mutations.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchHuman Heterozygous ENPP1 Deficiency Is Associated With Early Onset Osteoporosis, a Phenotype Recapitulated in a Mouse Model of Enpp1 Deficiency.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral ResearchFGF23 and Associated Disorders of Phosphate Wasting.
Pediatric endocrinology reviews : PERA Mutation in the Dmp1 Gene Alters Phosphate Responsiveness in Mice.
EndocrinologyAtraumatic diplaced bilateral femoral neck fracture in a patient with hypophosphatemic rickets in postpartum period: A missed diagnosis.
International journal of surgery case reportsSkeletal Muscle, but not Cardiovascular Function, Is Altered in a Mouse Model of Autosomal Recessive Hypophosphatemic Rickets.
Frontiers in physiologySclerostin antibody (Scl-Ab) improves osteomalacia phenotype in dentin matrix protein 1(Dmp1) knockout mice with little impact on serum levels of phosphorus and FGF23.
Matrix biology : journal of the International Society for Matrix BiologyTransgenic expression of Dspp partially rescued the long bone defects of Dmp1-null mice.
Matrix biology : journal of the International Society for Matrix BiologyHypophosphatemic rickets developed after treatment with etidronate disodium in a patient with generalized arterial calcification in infancy.
Bone reportsEarly onset hearing loss in autosomal recessive hypophosphatemic rickets caused by loss of function mutation in ENPP1.
Journal of pediatric endocrinology & metabolism : JPEMHypophosphatemic rickets: lessons from disrupted FGF23 control of phosphorus homeostasis.
Current osteoporosis reportsAssociações
Organizações que acompanham esta doença — pra ter apoio e orientação
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Comunidades
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Referências e fontes
Bases de dados externas citadas neste artigo
Publicações científicas
Artigos indexados no PubMed ligados a esta doença no grafo RarasNet — título, periódico e PMID direto da fonte, sem intermediação de IA.
- Phenotypic Diversity in Autosomal Recessive Hypophosphatemic Rickets Type 2.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research· 2026· PMID 41665285mais citado
- Autosomal recessive hypophosphatemic rickets type 2 (ARHR2): Is phosphate supplementation safe?
- Expanding the Autosomal Recessive Hypophosphatemic Rickets Type I Carrier Phenotype and Adult Treatment with Burosumab.
- Optimizing diagnosis and management of patients with ENPP1 deficiency: an expert opinion.
- Pediatric ABCC6 deficiency: a genotypic and phenotypic analysis.
- Six cases of ENPP1 pathogenic variants causing autosomal recessive hypophosphatemic rickets type 2 and generalized arterial calcification of infancy.
- A case and review of fibroblast growth factor-23-mediated hypophosphatemic osteomalacia in the absence of pathogenic PHEX variants.
Bases de dados e fontes oficiais
Identificadores e referências canônicas usadas para montar este verbete.
- ORPHA:289176(Orphanet)
- MONDO:0017324(MONDO)
- GARD:17320(GARD (NIH))
- Variantes catalogadas(ClinVar)
- Busca completa no PubMed(PubMed)
- Q21097764(Wikidata)
Dados compilados pelo RarasNet a partir de fontes abertas (Orphanet, OMIM, MONDO, PubMed/EuropePMC, ClinicalTrials.gov, DATASUS, PCDT/MS). Este conteúdo é informativo e não substitui avaliação médica.
Conteúdo mantido por Agente Raras · Médicos e pesquisadores podem colaborar
