Kidney Precision Medicine Clinic

Welcome to our kidney precision medicine clinic. The goal of our kidney precision medicine clinic is to deliver personalized kidney care to patients afflicted with kidney disease that may have an underlying genetic component. This individualized care starts with identifying patients who will benefit from genetic evaluation, performing the appropriate genetic testing, pre-test and post-test counseling patients and family and providing them with a management plan tailored according to the diagnosis.

How do your genes influence your kidneys?

It is becoming evident that many kidney diseases have a hereditable component, with significant diagnostic, prognostic, and therapeutic implications.

• About 10% of unselected patients with chronic kidney disease (CKD) have underlying genetic component.
• APOL1 gene variant is a strong risk factor for developing CKD and progressive loss of kidney function. About 13% of African Americans have APOL1 high risk gene variant.
• Autosomal dominant polycystic kidney disease affects 1 in 500 to 1,000 people.
• Many glomerular diseases have underlying genetic component, which influences the response to treatment. Some diseases may recur even after kidney transplantation.
• The nature of gene variation can affect the outcomes if one wants to donate a kidney to their loved ones.

Who should be seen in kidney precision medicine clinic?

You may benefit from a genetic testing if you have a strong family history of a kidney disease or any of the following:

• Early age of onset of kidney disease of unknown cause
• Cystic kidney diseases
• Alport syndrome
• Fabry’s disease
• Familial proteinuria (protein in urine)
• Familial hematuria (blood in urine)
• Anyone with family history of kidney disease of unknown cause
• Nephrotic syndrome resistant to treatment
• Those with family history of protein in urine or blood in urine
• Inherited kidney stone disease (Cystinosis)

Why should you be seen in kidney precision medicine clinic?

Our goal is to provide preventative and treatment plans for individuals who have a genetic cause of kidney disease.

• Some genetic disease affects more than one organ in our body. It is also known that certain genetic abnormalities increase the risk for specific cancers. Such individuals with specific gene variant need to be seen by other specialists to screen for involvement of other organs, screen for cancers and need long term follow up.
• African American kidney donors and kidney donor with a family history of kidney disease will benefit from genetic testing to evaluate their risk of developing kidney disease in the future after kidney donation.
• Some kidney disease can also recur after a kidney transplant. Transplant candidates with an unknown cause of end stage kidney disease with benefit from pre- transplant genetic testing to evaluate if their kidney disease can recur.
• Identify individuals who will benefit from implementing gene-based treatment.

What do we do in the kidney precision medicine clinic?

• After your initial evaluation in the clinic, we will test you for specific gene variation. The platform used for testing will depend on the underlying clinical presentation.
• Based on the results of the genetic testing, if any variation of clinical significance is detected, the results will be discussed with you and you will be provided with genetic counselling.
• Based on the gene variations, your treatment will be altered and individualized.
• You will be referred to appropriate dedicated specialists (cardiology, neurology, endocrinology, ophthalmologist, ear nose throat specialists, cancer specialist, kidney transplant team and urologist) for further investigation as warranted.

How do I get appointment in this clinic?

The kidney precision medicine clinic is led by Divya Shankaranarayanan, MD, an Assistant Professor of Medicine in the Division of Kidney Diseases and Hypertension. She is board certified in Internal Medicine and Nephrology. She also received additional clinical and research training in Transplantation Medicine and molecular biology from Cornel University.