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Practice Guideline
. 2022 Jun;101(6):1126-1141.
doi: 10.1016/j.kint.2022.03.019. Epub 2022 Apr 20.

Genetics in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

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Practice Guideline

Genetics in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

KDIGO Conference Participants. Kidney Int. 2022 Jun.

Abstract

Numerous genes for monogenic kidney diseases with classical patterns of inheritance, as well as genes for complex kidney diseases that manifest in combination with environmental factors, have been discovered. Genetic findings are increasingly used to inform clinical management of nephropathies, and have led to improved diagnostics, disease surveillance, choice of therapy, and family counseling. All of these steps rely on accurate interpretation of genetic data, which can be outpaced by current rates of data collection. In March of 2021, Kidney Diseases: Improving Global Outcomes (KDIGO) held a Controversies Conference on "Genetics in Chronic Kidney Disease (CKD)" to review the current state of understanding of monogenic and complex (polygenic) kidney diseases, processes for applying genetic findings in clinical medicine, and use of genomics for defining and stratifying CKD. Given the important contribution of genetic variants to CKD, practitioners with CKD patients are advised to "think genetic," which specifically involves obtaining a family history, collecting detailed information on age of CKD onset, performing clinical examination for extrarenal symptoms, and considering genetic testing. To improve the use of genetics in nephrology, meeting participants advised developing an advanced training or subspecialty track for nephrologists, crafting guidelines for testing and treatment, and educating patients, students, and practitioners. Key areas of future research, including clinical interpretation of genome variation, electronic phenotyping, global representation, kidney-specific molecular data, polygenic scores, translational epidemiology, and open data resources, were also identified.

Keywords: genetic kidney disease; genetic testing; genome-wide association studies; monogenic; polygenic; single-nucleotide polymorphism.

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Figures

Figure 1.
Figure 1.. Common Variant Contributions to Kidney Diseases and Traits., , , ,
*For binary outcomes, the proportions of phenotypic variance explained by loci from genome-wide association studies (GWAS) were estimated from Nagelkerke’s or McKelvey & Zavoina pseudo R2. SNP, single nucleotide polymorphism.
Figure 2.
Figure 2.. GWAS, Exome, or Genome Sequencing Studies. , , , , , -
*The largest study focused on urinary albumin-to-creatinine ratio. Several included serum albumin studies. **Pediatric population. ***For case-control studies, the total sample sizes were plotted. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; FSGS, focal segmental glomerulosclerosis; GWAS, genome-wide association studies; IgAN, IgA nephropathy; KF, kidney failure; LN, lupus nephritis; MCD, minimal change disease; MN, membranous nephropathy; Scr, serum creatinine; SRNS and SSNS, steroid-resistant and steroid-sensitive nephrotic syndrome; T1DM and T2DM, types 1 and 2 diabetes mellitus; WES, whole exome sequencing; WGS, whole genome sequencing.
Figure 3.
Figure 3.. Associations of APOL1 High Risk Genotype.-
APOL1 high-risk genotype: G1G1, G2G2, or G1G2 Studies were ordered by PMID, a proxy for publication date. *Compared with white patients APOL1, apolipoprotein L1; CKD, chronic kidney disease; DRC, Democratic Republic of Congo; FSGS, focal segmental glomerulosclerosis; HIVAN, HIV-associated nephropathy; HTN, hypertension; KF, kidney failure; LN, lupus nephritis; PMID, PubMed identifier.
Figure 4.
Figure 4.. Actionable Genes in Kidney Diseases.
Actionability refers to the potential for genetic test results to lead to specific clinical actions for prevention or treatment of a condition, supported by recommendations based on evidence. aHUS, atypical hemolytic uremic syndrome; SRNS, steroid-resistant nephrotic syndrome; RAAS, renin-angiotensin-aldosterone system.
Figure 5.
Figure 5.. Unified Disease Terminology.
Two-part (“dyadic”) naming comprises both the clinical condition and gene name. An example would be autosomal dominant tubulointerstitial kidney disease (ADTKD), in which ADTKD is followed by reference to the underlying genetic defect, such as ADTKD-UMOD. ADTKD, autosomal dominant tubulointerstitial kidney disease; PKD, polycystic kidney disease.
Figure 6.
Figure 6.. Proposed Organization for Implementing Genetics in Nephrology.
Within a health system, multiple center types, provider specialties, and education strategies are needed for best implementing genetics in nephrology. A three-tiered organization model includes 1) a basic, common level of knowledge in genetics among all nephrologists, 2) clinical connections between nephrologists and geneticists and genetic counselors, and 3) centers of expertise where nephrologists with genetic expertise collaborate with geneticists and genetic counselors. CME, continuing medical education.

References

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