Reviewed March 2013
What is Denys-Drash syndrome?
Denys-Drash syndrome is a condition that affects the kidneys and genitalia.
Denys-Drash syndrome is characterized by kidney disease that begins within the first few months of life. Affected individuals have a condition called diffuse glomerulosclerosis, in which scar tissue forms throughout glomeruli, which are the tiny blood vessels in the kidneys that filter waste from blood. In people with Denys-Drash syndrome, this condition often leads to kidney failure in childhood. People with Denys-Drash syndrome have an estimated 90 percent chance of developing a rare form of kidney cancer known as Wilms tumor. Affected individuals may develop multiple tumors in one or both kidneys.
Although males with Denys-Drash syndrome have the typical male chromosome pattern (46,XY), they have gonadal dysgenesis, in which external genitalia do not look clearly male or clearly female (ambiguous genitalia) or the genitalia appear completely female. The testes of affected males are undescended, which means they are abnormally located in the pelvis, abdomen, or groin. As a result, males with Denys-Drash are typically unable to have biological children (infertile).
Affected females usually have normal genitalia and have only the kidney features of the condition. Because they do not have all the features of the condition, females are usually given the diagnosis of isolated nephrotic syndrome.
How common is Denys-Drash syndrome?
The prevalence of Denys-Drash syndrome is unknown; at least 150 affected individuals have been reported in the scientific literature.
What genes are related to Denys-Drash syndrome?
Mutations in the WT1 gene cause Denys-Drash syndrome. The WT1 gene provides instructions for making a protein that regulates the activity of other genes by attaching (binding) to specific regions of DNA. On the basis of this action, the WT1 protein is called a transcription factor. The WT1 protein plays a role in the development of the kidneys and kidneys and gonads (ovaries in females and testes in males) before birth.
WT1 gene mutations that cause Denys-Drash syndrome lead to the production of an abnormal protein that cannot bind to DNA. As a result, the activity of certain genes is unregulated, which impairs the development of the kidneys and reproductive organs. Abnormal development of these organs leads to diffuse glomerulosclerosis and gonadal dysgenesis, which are characteristic of Denys-Drash syndrome. Abnormal gene activity caused by the loss of normal WT1 protein increases the risk of developing Wilms tumor in affected individuals.
Denys-Drash syndrome has features similar to another condition called Frasier syndrome, which is also caused by mutations in the WT1 gene. Because these two conditions share a genetic cause and have overlapping features, some researchers have suggested that they are part of a spectrum and not two distinct conditions.
Changes in this gene are associated with Denys-Drash syndrome.
How do people inherit Denys-Drash syndrome?
This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder.
Where can I find information about diagnosis or management of Denys-Drash syndrome?
These resources address the diagnosis or management of Denys-Drash syndrome and may include treatment providers.
- Gene Review: Wilms Tumor Overview (http://www.ncbi.nlm.nih.gov/books/NBK1294)
- Genetic Testing Registry: Drash syndrome (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0950121)
- MedlinePlus Encyclopedia: Nephrotic Syndrome (https://www.nlm.nih.gov/medlineplus/ency/article/000490.htm)
You might also find information on the diagnosis or management of Denys-Drash syndrome in
Educational resources and Patient support.
General information about the diagnosis (http://ghr.nlm.nih.gov/handbook/consult/diagnosis) and management (http://ghr.nlm.nih.gov/handbook/consult/treatment) of genetic conditions is available in the Handbook.
Read more about genetic testing (http://ghr.nlm.nih.gov/handbook/testing), particularly the difference between clinical tests and research tests (http://ghr.nlm.nih.gov/handbook/testing/researchtesting).
To locate a healthcare provider, see How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.
Where can I find additional information about Denys-Drash syndrome?
You may find the following resources about Denys-Drash syndrome helpful. These materials are written for the general public.
MedlinePlus - Health information
- Encyclopedia: Ambiguous Genitalia (https://www.nlm.nih.gov/medlineplus/ency/article/003269.htm)
- Encyclopedia: Nephrotic Syndrome (https://www.nlm.nih.gov/medlineplus/ency/article/000490.htm)
- Health Topic: Kidney Diseases (https://www.nlm.nih.gov/medlineplus/kidneydiseases.html)
- Health Topic: Kidney Failure (https://www.nlm.nih.gov/medlineplus/kidneyfailure.html)
- Health Topic: Wilms Tumor (https://www.nlm.nih.gov/medlineplus/wilmstumor.html)
Additional NIH Resources - National Institutes of Health
- National Cancer Institute: Wilms Tumor and Other Childhood Kidney Tumor Treatment PDQ (http://www.cancer.gov/types/kidney/patient/wilms-treatment-pdq)
- National Institute of Diabetes and Digestive and Kidney Diseases: Glomerular Diseases (http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/glomerular-diseases/Pages/facts.aspx)
Educational resources - Information pages
- Disease InfoSearch: Denys-Drash syndrome (http://www.diseaseinfosearch.org/Denys-Drash+syndrome/9790)
- Johns Hopkins Medicine: Glomerulosclerosis (http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/kidney_and_urinary_system_disorders/glomerulosclerosis_85,P01475/)
- Merck Manual Consumer Version: Wilms' Tumor (http://www.merckmanuals.com/home/children-s-health-issues/childhood-cancers/wilms-tumor)
- Merck Manual for Health Care Professionals: Nephrotic Syndrome (http://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/overview-of-nephrotic-syndrome.html?qt=&sc=&alt=)
- Orphanet: Denys-Drash syndrome (http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=220)
Patient support - For patients and families
- American Cancer Society: Wilms Tumor (http://www.cancer.org/cancer/wilmstumor/index)
- American Childhood Cancer Organization: Wilms' Tumor (http://www.acco.org/about-childhood-cancer/diagnosis/types-of-childhood-cancer/wilms-tumor-and-other-childhood-kidney-tumors/)
- March of Dimes: Genital and Urinary Tract Defects (http://www.marchofdimes.org/baby/genital-and-urinary-tract-defects.aspx)
- National Kidney Foundation (https://www.kidney.org/)
- National Organization for Rare Disorders (NORD) (http://rarediseases.org/rare-diseases/denys-drash-syndrome/)
- University of Kansas Resource List: Kidney/Urological Conditions (http://www.kumc.edu/gec/support/kidney.html)
- University of Kansas Resource List: Sexuality and Sexual Differentiation Syndromes (http://www.kumc.edu/gec/support/ambig.html)
You may also be interested in these resources, which are designed for healthcare professionals and researchers.
- Gene Reviews - Clinical summary (http://www.ncbi.nlm.nih.gov/books/NBK1294)
Genetic Testing Registry - Repository of genetic test information
- Genetic Testing Registry: Drash syndrome (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0950121)
- ClinicalTrials.gov - Linking patients to medical research (https://clinicaltrials.gov/ct2/results?cond=%22Denys-Drash%20syndrome%22)
- PubMed - Recent literature (http://www.ncbi.nlm.nih.gov/pubmed?term=%28Denys-Drash%20syndrome%5BTIAB%5D%29%20AND%20english%5Bla%5D%20AND%20human%5Bmh%5D%20AND%20%22last%201800%20days%22%5Bdp%5D)
- OMIM - Genetic disorder catalog (http://omim.org/entry/194080)
What other names do people use for Denys-Drash syndrome?
- Drash syndrome
- nephropathy, Wilms tumor, and genital anomalies
- Wilms tumor and pseudohermaphroditism
For more information about naming genetic conditions, see the Genetics Home Reference
Condition Naming Guidelines (http://ghr.nlm.nih.gov/ConditionNameGuide)
How are genetic conditions and genes named? (http://ghr.nlm.nih.gov/handbook/mutationsanddisorders/naming) in the Handbook.
What if I still have specific questions about Denys-Drash syndrome?
Ask the Genetic and Rare Diseases Information Center (https://rarediseases.info.nih.gov/gard).
What glossary definitions help with understanding Denys-Drash syndrome?
autosomal dominant ;
transcription factor ;
You may find definitions for these and many other terms in the Genetics Home Reference
- Andrade JG, Guaragna MS, Soardi FC, Guerra-Júnior G, Mello MP, Maciel-Guerra AT. Clinical and genetic findings of five patients with WT1-related disorders. Arq Bras Endocrinol Metabol. 2008 Nov;52(8):1236-43. (http://www.ncbi.nlm.nih.gov/pubmed/19169475?dopt=Abstract)
- Dai YL, Fu JF, Hong F, Xu S, Shen Z. WT1 mutation as a cause of 46 XY DSD and Wilm's tumour: a case report and literature review. Acta Paediatr. 2011 Jul;100(7):e39-42. doi: 10.1111/j.1651-2227.2011.02167.x. Epub 2011 Feb 14. Review. (http://www.ncbi.nlm.nih.gov/pubmed/21314844?dopt=Abstract)
- Guaragna MS, Soardi FC, Assumpção JG, Zambaldi Lde J, Cardinalli IA, Yunes JA, de Mello MP, Brandalise SR, Aguiar Sdos S. The novel WT1 gene mutation p.H377N associated to Denys-Drash syndrome. J Pediatr Hematol Oncol. 2010 Aug;32(6):486-8. doi: 10.1097/MPH.0b013e3181e5e20d. (http://www.ncbi.nlm.nih.gov/pubmed/20562648?dopt=Abstract)
- Niaudet P, Gubler MC. WT1 and glomerular diseases. Pediatr Nephrol. 2006 Nov;21(11):1653-60. Epub 2006 Aug 23. Review. (http://www.ncbi.nlm.nih.gov/pubmed/16927106?dopt=Abstract)
- Yue Z, Pei Y, Sun L, Huang W, Huang H, Hu B, Yang J, Jiang X, Mo Y, Chen S, Lai KN, Wang Y. Clinical pictures and novel mutations of WT1-associated Denys-Drash syndrome in two Chinese children. Ren Fail. 2011;33(9):910-4. doi: 10.3109/0886022X.2011.605528. Epub 2011 Aug 18. (http://www.ncbi.nlm.nih.gov/pubmed/21851196?dopt=Abstract)
The resources on this site should not be used as a substitute for
professional medical care or advice. Users seeking information about
a personal genetic disease, syndrome, or condition should consult with a qualified
See How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.