Table 1.

Next-Gen Nephrology: Opportunities and Challenges

Step	Key questions	Helpful strategies
Refer patient for genetic testing	For which patients is genetic testing indicated? How to ensure all patients have equal access to genetic testing?	Large sequencing studies in diverse CKD patient cohorts to ascertain indications for genetic testing in nephrology Culturally sensitive outreach initiatives to facilitate access for minority and underserved populations
Clinical sequence interpretation	How to identify diagnostic variants amidst the vast amount of sequence data generated by genome-wide testing?	Creation of disease-specific variant interpretation guidelines for different hereditary nephropathies Use of diverse control population genetic databases to help filter a patient’s sequence data Clinical database review and correction of misclassified variants
Return of results	Which results warrant return? How should they be returned to the patient?	Consensus guidelines regarding which results merit return, given the clinical context Patient education and pre- and post-test counseling to ensure informed consent and empower individuals’ decision-making
Apply genetic findings to provide personalized care	What is clinical significance of the genetic findings, and the indicated workup and management? How to protect patients from genetic discrimination and other misuse of genetic data?	Long-term studies of the impact of genetic findings on clinical outcomes to enable creation of best practice guidelines for workup and treatment EHR tools to help physicians utilize genetic findings in everyday clinical care Further legislative efforts to protect the autonomy and privacy of patients undergoing genetic testing