Evolution-informed therapy for kidney disease.

A recent editorial highlighted the challenges of bridging the great divides between evolutionists and clinicians [1]. Global prevalence of chronic kidney disease is rapidly increasing and affects African Americans at 4-fold the rate for European Americans [2,3]. Social inequalities contribute to many health disparities affecting African Americans, and the discovery of G1 and G2 APOL1 gene variants prevalent in 13% of this population contributes to the genetic component of the excess risk for nondiabetic kidney failure [4]. Focal segmental glomerulosclerosis (FSGS), the most common primary glomerular disorder causing kidney failure in the USA, is also more common in persons of African than European origin [5]. Importantly, FSGS is associated with the APOL1 gene variants common in African chromosomes but absent in European chromosomes [6]. With the exception of SGLT2 inhibitors [7], effective therapies to slow or prevent progression of FSGS are not currently available. EVOLUTIONARY PERSPECTIVES