Division of Nephrology and Hypertension, Department of Medicine, Georgetown University School of Medicine, Washington, DC.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
Am J Kidney Dis. 2024 Nov;84(5):632-645. doi: 10.1053/j.ajkd.2024.05.011. Epub 2024 Sep 26.
Implementation of clinical genetic testing into the routine diagnostic workup of patients with kidney disorders can improve care when employed with proper patient selection. Due to advances in technology, testing with curated gene panels associated with kidney diseases are commercially available, are relatively inexpensive, and have quick turnaround time. While this may reduce barrier to entry, their adoption into routine nephrology care may be hindered when practitioners do not have comfort and experience ordering or interpreting these tests. Identifying patients who may have a monogenic etiology of their kidney disease will increase the diagnostic yield of testing, avoid unnecessary use of resources, and reduce anxiety around unclear or secondary findings. Genetic testing can end one's diagnostic odyssey and help identify other family members at risk. Additionally, obtaining a genetic result can aid diagnostic precision, enhance understanding of disease, and may allow for alterations in treatment plans and screening for extrarenal manifestations of disease as well as clarify prognosis and aid in family planning. In this Core Curriculum, using a case-based approach, we highlight these and other topics in clinical genetic testing to enhance utilization in the general nephrology patient population.
将临床基因检测纳入肾脏疾病患者的常规诊断工作中,可以在适当选择患者的情况下改善治疗效果。由于技术的进步,与肾脏疾病相关的经过精心挑选的基因组合检测试剂盒已经商业化,价格相对较低,且周转时间较快。虽然这可能降低了准入门槛,但如果从业者在订购或解读这些检测时感到不舒服或缺乏经验,它们可能难以被常规应用于肾病学护理。识别出可能存在单基因病因的肾脏疾病患者,将提高检测的诊断效果,避免不必要的资源使用,并减轻对不明确或次要发现的焦虑。基因检测可以结束诊断的探索过程,并帮助识别其他有患病风险的家族成员。此外,获得基因检测结果可以辅助诊断的精准性,加深对疾病的理解,并可能改变治疗计划,筛查肾脏以外疾病的表现,还可以明确预后并帮助进行家庭规划。在本核心课程中,我们将采用基于案例的方法,重点介绍临床基因检测的这些和其他主题,以增强在一般肾病患者群体中的应用。