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. Author manuscript; available in PMC: 2023 Jun 1.
Published in final edited form as: Kidney Int. 2022 Apr 20;101(6):1126–1141. doi: 10.1016/j.kint.2022.03.019

Table 1.

Summary Points From the Genetics in CKD Controversies Conference

Consensus
  • Monogenic and complex kidney diseases exist on a continuum, but dichotomous categories are useful for practical distinction.

  • There is no upper age-limit for monogenic CKD.

  • Actionable genes in kidney diseases refers to genes in which the identification of pathogenic variants can lead to specific clinical actions for treatment or prevention, following recommendations based on evidence.

  • There is a need for developing a reference kidney disease gene list and standardization of gene/variant reporting for kidney diseases.

  • A larger workforce with expertise in kidney genetics, genomics, and computational research is needed.

  • Education of the workforce is necessary for successful implementation of genetic testing in clinical nephrology.

  • More studies are needed that include diverse populations worldwide to ensure equitable and generalizable implementation of genetic testing, obtain evidence of causality, establish global prevalence, and facilitate variant discovery

  • Interdisciplinary expert boards (including nephrologists, clinical geneticists, molecular biologists, genetic counselors) should be assembled for discussing potential genetic diagnostic findings and counsel primary and secondary care centers.

  • Genomics should be integrated into clinical trials on kidney diseases.

  • Estimates of the prevalence of monogenic CKD are important but currently imprecise due to selection bias.

Ongoing controversies
Definitions/terminology
  • Two-part names (clinical condition PLUS gene name) are preferred for more precise disease terminology.

  • The term CKD of unknown etiology is not clear and in need of consensus.

  • There is no clear consensus on which VUS are to be reported in the frame of diagnostic testing.

Processes for improving data capture and analysis
  • Improve phenotyping, including methods for electronic phenotyping.

  • Improve the quality of genomic studies, including analytical and computational methods.

  • Improve data access while protecting the privacy of research participants.

  • Create processes for transferring genetic information obtained through clinical testing to research.

  • Study health-economic impacts of genetic testing in nephrology.

  • Establish a process for periodic reanalysis of unsolved cases with kidney disease.

  • Implement high-throughput techniques for in silico and in vitro variant characterization.

  • Identify and characterize rare variants, structural variants, and functional variants using functional genomic, epigenetic, and other multi-omic approaches.

  • Employ new approaches to identify more homogeneous CKD phenotypes and subclassifications for genetic studies, e.g. using non-traditional omics biomarkers, electronic health record data, imaging, or machine learning.

  • Assemble larger cohorts with genetically defined kidney disease for both research and clinical trials; collaborate internationally if possible.

  • Reduce measurement errors in eGFR and misclassification in the resulting CKD definition, e.g. reassess coefficients based on race, sex, and chronological age in eGFR equations.

  • Conduct large-scale genetic studies on specific kidney sub-phenotypes, e.g. CKD progression, acute kidney injury, cause-specific disease severity, and manifestations.

  • Integrate genetic studies with biomarker and multi-omic profiling to leverage findings and increase power for both variant and pathway identification.

  • Generate comprehensive molecular maps of kidney tissue/cells as well as in vitro and animal models to enable mechanistic studies of genes identified in GWAS of kidney traits.

  • Encourage broad data sharing (FAIR principals: Findable, Accessible, Interoperable, Reusable), transparent protocols for data generation, quality control, and analyses.

  • Use federated networks to standardize key data elements across platforms and countries.

  • Use portals (cloud-based) to “safely” share individual data and allow for democratization and broader scale of integrative in silico analyses.

  • Extend discovery analyses to non-additive genetic models (e.g. recessive) and include non-autosomal regions (e.g. chromosome X, mitochondrial).

  • Improve imputation reference panels.

  • Apply and develop approaches specific to admixed populations.

  • Conduct Mendelian randomization analysis to elucidate causal mechanisms.

Priorities for Implementation
  • Increase genetic and genomic resources in underrepresented populations with kidney disease.

  • Investigate the use of polygenic scores in clinical settings.

  • Develop guidelines for nephrologist core competencies in genetics, develop evaluations to test them, and identify the educational gaps of general nephrologists (some need to be country specific).

  • Develop and test the impact of dissemination tools to spread the basic knowledge required for all nephrologists.

  • Measure the quality of existing or to-be-established genetic subspecialty training for nephrologists as well as training in nephrology for genetic counselors and molecular geneticists (variant interpretation side).

  • Develop guidelines for the referral of nephrology patients to genetic counseling/genetic testing/reproductive counseling.

  • Analyze the impact of genetic testing on clinical outcomes of nephrology patients.

  • Analyze the cost-effectiveness and longitudinal clinical utility of genetic testing.

  • Analyze the impact of centers of expertise on quality of care and patient outcomes.

CKD, chronic kidney disease; VUS, variants of uncertain significance