Kidney Volume and Risk of Incident Kidney Outcomes.

BACKGROUND: Low total kidney volume (TKV) is a risk factor for chronic kidney disease (CKD). However, evaluations of nonlinear relationships, incident events, causal inference, and prognostic utility beyond traditional biomarkers are lacking. METHODS: TKV, height-adjusted TKV, and body surface area-adjusted TKV (BSA-TKV) of 34,595 White British ancestry participants were derived from the UK Biobank. Association with incident CKD, acute kidney injury (AKI), and cardiovascular events were assessed with Cox proportional hazard models. Prognostic thresholds for CKD risk stratification were identified using a modified Mazumdar method with bootstrap resampling. Two-sample Mendelian randomization was performed to assess the bidirectional association of genetically predicted TKV with kidney and cardiovascular traits. RESULTS: Adjusted for eGFR and albuminuria, a lower TKV of 10 mL was associated with a 6% higher risk of incident CKD (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03 to 1.08, P = 5.8 x 10-6) in contrast to no association with incident AKI (HR 1.00, 95% CI 0.98 to 1.02, P = 0.66). Comparison of nested models demonstrated improved accuracy over the CKD Prognosis Consortium Incident CKD Risk Score with the addition of BSA-TKV or prognostic thresholds at 119 (10th percentile) and 145 mL/m2 (50th percentile). In Mendelian randomization, a lower genetically predicted TKV by 10 mL was associated with 10% higher CKD risk (odds ratio [OR] 1.10, 95% CI 1.06 to 1.14, P = 1.3 x 10-7). Reciprocally, an elevated risk of genetically predicted CKD by 2-fold was associated with a lower TKV by 7.88 mL (95% CI -9.81 to -5.95, P = 1.2 x 10-15). There were no significant observational or Mendelian randomization associations of TKV with cardiovascular complications. CONCLUSIONS: Kidney volume was associated with incident CKD independent of traditional risk factors including baseline eGFR and albuminuria. Mendelian randomization demonstrated a bidirectional relationship between kidney volume and CKD.

The Good and the Bad of SHROOM3 in Kidney Development and Disease: A Narrative Review.

Purpose of review: Multiple large-scale genome-wide association meta-analyses studies have reliably identified an association between genetic variants within the SHROOM3 gene and chronic kidney disease. This association extends to alterations in known markers of kidney disease including baseline estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, and blood urea nitrogen. Yet, an understanding of the molecular mechanisms behind the association of SHROOM3 and kidney disease remains poorly communicated. We conducted a narrative review to summarize the current state of literature regarding the genetic and molecular relationships between SHROOM3 and kidney development and disease. Sources of information: PubMed, PubMed Central, SCOPUS, and Web of Science databases, as well as review of references from relevant studies and independent Google Scholar searches to fill gaps in knowledge. Methods: A comprehensive narrative review was conducted to explore the molecular mechanisms underlying SHROOM3 and kidney development, function, and disease. Key findings: SHROOM3 is a unique protein, as it is the only member of the SHROOM group of proteins that regulates actin dynamics through apical constriction and apicobasal cell elongation. It holds a dichotomous role in the kidney, as subtle alterations in SHROOM3 expression and function can be both pathological and protective toward kidney disease. Genome-wide association studies have identified genetic variants near the transcription start site of the SHROOM3 gene associated with chronic kidney disease. SHROOM3 also appears to protect the glomerular structure and function in conditions such as focal segmental glomerulosclerosis. However, little is known about the exact mechanisms by which this protection occurs, which is why SHROOM3 binding partners remain an opportunity for further investigation. Limitations: Our search was limited to English articles. No structured assessment of study quality was performed, and selection bias of included articles may have occurred. As we discuss future directions and opportunities, this narrative review reflects the academic views of the authors.

Contexte motivant la revue: Plusieurs méta-analyses d'envergure portant sur des études d'association pangénomiques ont permis d'identifier de manière fiable une association entre des variants génétiques du gène SHROOM3 et l'insuffisance rénale chronique. Cette association s'étend aux altérations des marqueurs connus de l'insuffisance rénale, notamment le débit de filtration glomérulaire estimé initial, le rapport albumine/créatinine urinaire et le taux d'urée dans le sang. Pourtant, la compréhension des mécanismes moléculaires qui sous-tendent cette association entre SHROOM3 et l'insuffisance rénale reste mal communiquée. Nous avons procédé à une revue narrative afin de résumer l'état actuel de la littérature en ce qui concerne les relations génétiques et moléculaires entre SHROOM3 et le développement des reins et de l'insuffisance rénale. Sources: Les bases de données PubMed, PubMed Central, SCOPUS et Web of Science. L'examen des références des études pertinentes et des recherches indépendantes sur Google Scholar a également été réalisé pour combler les lacunes dans les connaissances. Méthodologie: Une revue narrative complète a été effectuée afin d'explorer les mécanismes moléculaires qui sous-tendent SHROOM3, le développement des reins, la fonction rénale et l'insuffisance rénale. Principaux résultats: SHROOM3 est une protéine unique puisqu'elle est la seule du groupe de protéines SHROOM à réguler la dynamique de l'actine par la constriction apicale et l'élongation des cellules apico-basales. SHROOM3 joue un rôle dichotomique dans le rein; de subtiles altérations de son expression et de sa fonction pouvant à la fois être pathologiques ou protectrices en contexte d'insuffisance rénale. Des études d'association pangénomiques ont permis d'identifier des variants génétiques associés à l'insuffisance rénale chronique près du site d'initiation de la transcription du gène SHROOM3. SHROOM3 semble également protéger la structure et la fonction des glomérules dans des contextes comme la glomérulosclérose segmentaire focale. On en sait toutefois peu sur les mécanismes précis qui entraînent cette protection; les partenaires de liaison de SHROOM3 demeurent par conséquent d'intéressantes avenues pour une étude plus approfondie. Limites: Notre recherche était limitée aux articles rédigés en anglais. Les études pertinentes n'ont pas fait l'objet d'une évaluation structurée de leur qualité. Un biais de sélection des articles inclus peut s'être produit. Bien que nous discutions des orientations et des possibilités futures, cette revue narrative reflète les points de vue académiques des auteurs.