[Genetics and oncogenesis of renal cancer]

The development and progression of cancer requires several genetic modifications. Multiple transformation and progression events such as point mutations, deletions/insertions, chromosomal abnormalities, and epigenetic deregulation contribute to renal oncogenesis. Three types of genes are involved in this multistep process: oncogenes, tumor suppressor genes, and DNA repair genes. About 4% of renal tumors are hereditary, i.e., the first mutation is present at the constitutive level in all cells of an individual, leading to an increased lifetime risk of cancer. Sporadic tumors are mainly single and of late onset, while hereditary tumors are usually multiple and of early onset in the presence of a positive family history for kidney cancer. Moreover, hereditary tumors are often associated with specific syndromic signs. The main hereditary syndromes that include renal tumors are Von Hippel- Lindau disease, hereditary papillary renal clear cell carcinoma, hereditary leiomyomatosis renal cell carcinoma, and the Birt-Hogg-Dube' syndrome. Other rarer conditions are chromosome 3 translocation, tuberous sclerosis, and the Lynch syndrome. Study of these diseases and identification of the responsible genes have been extremely useful in understanding several molecular issues of renal oncogenesis. Genetic testing makes it possible to diagnose hereditary cancer and confirm a clinical suspicion, as well as to identify at-risk individuals within a family. It is extremely important for nephrologists to be aware of these hereditary conditions, as this will allow early recognition and improved clinical management.