DNA Replication Enzyme Defects (Eukaryotic):
DNA Pol Ξ΅ (POLE) mut β†’ ↓ proofreading β†’ 𝐜𝐨π₯𝐨𝐫𝐞𝐜𝐭𝐚π₯ 𝐜𝐚𝐧𝐜𝐞𝐫; MMR gene mut (MLH1, MSH2, MSH6, PMS2; linked to Pol Ξ΄/III proofreading) β†’ π‹π²π§πœπ‘ 𝐬𝐲𝐧𝐝𝐫𝐨𝐦𝐞 (𝐇𝐍𝐏𝐂𝐂) β†’ microsatellite instability (MSI) tumors; DNA Pol I (prokaryotes) excises RNA primers (5β€²β†’3β€² exonuclease) + fills gaps β†’ loss β†’ ↑ mutation rate; global replication enzyme defects β†’ genomic instability, ↑ 𝐜𝐚𝐧𝐜𝐞𝐫 𝐫𝐒𝐬𝐀, recurrent infections, inherited syndromes.
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Nephrogenic DI: polyuria (>3 L/day), polydipsia, dehydration despite adequate ADH
Causes: lithium, demeclocycline, foscarnet, amphotericin B, genetic (AQP2/V2R), hypercalcemia, hypokalemia, renal disease
Pathophys: ADH present but ↓ signaling β†’ ↓ AQP2 insertion β†’ ↓ water reabsorption in collecting ducts
Dx: urine SG <1.010, Β± hypernatremia, no concentration after water deprivation (central DI would fully concentrate with DDAVP)

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