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Hypertension-attributed nephropathy: what's in a name?
Barry I Freedman1, Arthur H Cohen2
1Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053, USA.
Nature Reviews. Nephrology
|November 11, 2015
Summary
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.
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.
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