Precision Nephrology in Genomic Era
Chronic Kidney Disease (CKD) is a major global health problem with significant morbidity and mortality and high economic burden in various geographic communities. During the 20th century, nephrology clinical practice witnessed significant achievements thanks to major technological advances that enabled provision of dialysis and transplantation to ESRD patients.
But what about nephrology in the 21st century?
The goal of “precision medicine” is to molecularly characterize diseases, in order to identify specific biomarkers and therapeutic targets that will ultimately improve clinical outcomes. The nephrology research community has developed a strong foundation for precision medicine, and recent publications demonstrate the “feasibility” of this approach to identify potential biomarkers and therapeutic targets in chronic kidney disease.
Over the past decade, rapidly growing knowledge in genomics and genomic technologies have immensely impacted nephrology clinical practice and resulted in a greater integration of genetics into nephrology healthcare:
i) providing a definitive diagnosis; ii) enabling precise genetic counselling for family planning; iii) providing guidance for monitoring of potential future complications; iv) providing guidance of transplantation strategy and evaluation of family member potential kidney donors.
Having said that, nephrology is still lagging behind other disciplines, oncology for instance, in fully integrating genetics into nephrology clinical care. With the dramatic improvement of sequencing technologies and the enormous reduction of sequencing cost, it is high time for nephrologists to face the resulting genetic data avalanche.
1. How well are we in coping with this plethora of genetic data and utilizing it properly so far?
2. Are there innovations in the pipeline for disease-specific biomarkers and/or new technologies or therapeutics targeted at enhancing the provided care, particularly in this rapidly growing genomic era?
3. Is there a strategic framework towards customization of provided healthcare in nephrology, with tailored medical decisions and targeted therapeutics?
This remains to be answered!
- Wyatt & Schlondorff. Precision medicine comes of age in nephrology: identification of novel biomarkers and therapeutic targets for chronic kidney disease. Kidney Int. 2016 Apr;89(4):734-7
- Poliakov et al. Genetics in Genomic Era. Genet Res Int. 2015; 2015: 364960