Familial clustering of end-stage renal disease in Mississippi

Familial clustering of ESRD has been noted in the families of 20-40% of African-Americans (AA) with ESRD but has been observed much less often in Caucasians (Cau). Because our impression indicated a higher frequency in Caucasians than reported in several recent studies we conducted a 2-year prospective evaluation of patients referred for renal transplantation to assess the frequency of familial clustering of ESRD in both Caucasians and African-Americans.

Detailed family histories were obtained in 350 ESRD patients referred for renal transplantation, 335 of whom could provide appropriate information regarding first- and second-degree family members (252AA and 83 Cau) who were maintained on out-patient dialysis at least one month or had received a renal transplant.

Patient race and sex paralleled that of the current Mississippi ESRD population but mean age was 17 years younger in the transplant candidates (39.9 vs. 57.2 yrs). If polycystic kidney disease (PKD) is included in the analysis, 31.7% of AA and 30.1% of Cau had at least one other family member with ESRD. If PKD is eliminated then 30.9% of AA and 25% of Cau had at least one other family member with ESRD. In both races the frequency of a positive family history was greatest in index cases with chronic glomerulonephritis, and of those with renal biopsies (n = 59), patients with focal segmental glomerulosclerosis (FSGS) and systemic lupus erythematosus (SLE) had the strongest family histories of ESRD (40% and 36%, respectively). Cau and AA with FSGS had comparable familial clustering of ESRD (41% vs, 38%) but SLE was confined to AA.

In younger individuals with ESRD, familial clustering of end stage renal disease occurs with almost equal frequency in Caucasians and in African Americans. Screening of family members of index cases in both races might define a high-risk group of patients in whom prophylactic measures might be directed to thwart the progression [table: see text] of renal failure.