Renal disease: environment, race, or genes?
Diabetic nephropathy is over-represented in people of color. This reflects both environmental and genetic factors. Numerous studies assess the effects of access to care and patient adherence in the development of kidney diseases. After correcting for these factors, genetic influences remain. Genetic approaches to discerning genes that predispose to diabetic nephropathy include candidate gene approaches, linkage analysis, mapping by admixture linkage disequilibrium, and transmission disequilibrium testing. Numerous candidate genes have been identified, although few have been confirmed apart from those representing genes in the renin-angiotensin system. The results of linkage analysis studies have similarly resulted in genomic regions purported to show linkage in a variety of ethnic groups that have most often not been confirmed in other ethnic groups, and sometimes in other groups of similar ethnicity but different phenotype definitions. The chromosomal regions determining glomerular filtration rate do not appear to be localized to the same chromosome as those related to proteinuria. Large cohorts of subjects have now been amassed by numerous research groups, and genome-wide scanning results involving much larger cohorts are anticipated to be published in the next few years. It is hoped that these strategies will ultimately identify chromosomsal regions and/ or genes that confer risk for diabetic nephropathy, and in so doing, provide clues to new therapies.
Adler
Sharon
S
David Geffen School of Medicine at UCLA, Los Angeles Biomedical Research Institute at Harbor-UCLA, Division of Nephrology and Hypertension, 1124 West Carson St, Torrance, CA 90502, USA. sadler@LABiomed.org
D001741:Black or African American / Q000235:genetics; D044467:American Indian or Alaska Native / Q000235:genetics; D001213:Asian / Q000235:genetics; D003928:Diabetic Nephropathies / Q000208:ethnology* / Q000235:genetics* / Q000517:prevention & control; D020022:Genetic Predisposition to Disease / Q000208:ethnology*; D006801:Humans; D011110:Polymorphism, Genetic; D012307:Risk Factors; D014481:United States / Q000453:epidemiology