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Hypertension-attributed nephropathy: what's in a name?

Barry I Freedman1, Arthur H Cohen2

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Hypertension is often misdiagnosed as the cause of chronic kidney disease. Genetic testing can differentiate APOL1-associated glomerulosclerosis from arteriolar nephrosclerosis, improving diagnosis and treatment.

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Area of Science:

  • Nephrology
  • Genetics
  • Precision Medicine

Background:

  • Chronic kidney disease (CKD) in patients with hypertension and low proteinuria is often misdiagnosed.
  • Two distinct conditions, primary glomerulosclerosis (often APOL1-mediated) and arteriolar nephrosclerosis, are frequently conflated under the term 'hypertensive nephrosclerosis'.

Purpose of the Study:

  • To advocate for the abandonment of the term 'hypertensive nephrosclerosis'.
  • To promote the use of precise, gene-based diagnostic terms like 'APOL1-associated glomerulosclerosis' or 'arteriolar nephrosclerosis'.
  • To highlight the role of genetic testing in accurate disease definition and management.

Main Methods:

  • Review of existing literature on CKD pathogenesis in hypertensive patients.
  • Analysis of the role of apolipoprotein L1 (APOL1) gene variants in kidney disease.
  • Discussion of the implications of genetic testing for diagnostic accuracy.

Main Results:

  • APOL1-associated nephropathies are distinct from hypertensive arteriolar nephrosclerosis, despite often causing secondary hypertension.
  • Genetic testing for APOL1 variants and other glomerulosclerosis-associated genes can precisely define disease pathogenesis.
  • Accurate discrimination of these disorders is crucial for effective treatment and potential eradication of APOL1-related kidney diseases.

Conclusions:

  • The term 'hypertensive nephrosclerosis' is imprecise and should be replaced with specific diagnoses.
  • Adoption of gene-based terminology and precision medicine will enhance diagnostic accuracy in nephrology.
  • Distinguishing between APOL1-associated glomerulosclerosis and arteriolar nephrosclerosis is essential for advancing patient care.