Monogenic causes of chronic kidney disease in adults

• DOI: 10.1016/j.kint.2018.10.031
• Publication Date: 2019-02-14T09:04:04Z
• Authors: Dervla M. Connaug...; Claire Kennedy; Shirlee Shril; Nina Mann; Susan L. Murray; Patrick A. Williams; Eoin Conlon; Makiko Nakayama; Amelie T. van der...; Hadas Ityel; Franziska Kause; Caroline M. Kolve...; Rufeng Dai; Asaf Vivante; Daniela A. Braun; Ronen Schneider; Thomas M. Kitzler; Brona Moloney; Conor P. Moran; John S. Smyth; Alan Kennedy; Katherine Benson; Caragh Stapleton; Mark Denton; Colm Magee; Conall M. O’Seaghdha; William D. Plant; Matthew D. Griffin; Atif Awan; Clodagh Sweeney; Shrikant M. Mane; Richard P. Lifton; Brenda Griffin; Sean Leavey; Liam Casserly; Declan G. de Freitas; John Holian; Anthony Dorman; Brendan Doyle; Peter J. Lavin; Mark A. Little; Peter J. Conlon; Friedhelm Hildebr...
• Keywords: Adult; Aged, 80 and over; Male; Adolescent; Middle Aged; Kidney; 3. Good health; Pedigree; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Mutation; Humans; Exome; Female; Genetic Predisposition to Disease; Genetic Testing; Age of Onset; Precision Medicine; Renal Insufficiency, Chronic; Medical History Taking; Ireland; Aged

Approximately 500 monogenic causes of chronic kidney disease (CKD) have been identified, mainly in pediatric populations. The frequency of monogenic causes among adults with CKD has been less extensively studied. To determine the likelihood of detecting monogenic causes of CKD in adults presenting to nephrology services in Ireland, we conducted whole exome sequencing (WES) in a multi-centre cohort of 114 families including 138 affected individuals with CKD. Affected adults were recruited from 78 families with a positive family history, 16 families with extra-renal features, and 20 families with neither a family history nor extra-renal features. We detected a pathogenic mutation in a known CKD gene in 42 of 114 families (37%). A monogenic cause was identified in 36% of affected families with a positive family history of CKD, 69% of those with extra-renal features, and only 15% of those without a family history or extra-renal features. There was no difference in the rate of genetic diagnosis in individuals with childhood versus adult onset CKD. Among the 42 families in whom a monogenic cause was identified, WES confirmed the clinical diagnosis in 17 (40%), corrected the clinical diagnosis in 9 (22%), and established a diagnosis for the first time in 16 families referred with CKD of unknown etiology (38%). In this multi-centre study of adults with CKD, a molecular genetic diagnosis was established in over one-third of families. In the evolving era of precision medicine, WES may be an important tool to identify the cause of CKD in adults.