FAMILIAL PREDISPOSITION TO NEPHROPATHY IN AFRICAN-AMERICANS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Nephropathy clusters in Pima Indian families with non-insulin-dependen t diabetes mellitus (NIDDM), suggesting that susceptibility to nephrop athy is distinct from NIDDM per se. The authors compared the family hi story of endstage renal disease (ESRD) from 52 African-American patien ts with NIDDM-induced ESRD (cases) with 45 age-, sex-, and race-matche d non-insulin-dependent diabetics without nephropathy (controls) to as sess whether the risk of renal disease was independent from NIDDM in A frican-Americans as well. Thirty-seven percent (19 of 52) of NIDDM-ind uced ESRD patients had either a first-, second-, or third-degree relat ive with ESRD, in contrast to only 7% (3 of 45) of diabetic controls. African-American individuals with NIDDM were at eightfold increased ri sk for developing subsequent ESRD in the presence of a close relative with ESRD (odds ratio = 8.06; 95% confidence interval, 2.2 to 29.6; P less than or equal to 0.0005). No significant differences were observe d in yearly income, years of formal education, total serum cholesterol level, prevalence of smoking, or hypertension between the groups. Dia betic control (assessed by glycosylated hemoglobin and random glucose levels) was suboptimal in nonrenal disease controls, suggesting that h yperglycemia alone fails to cause nephropathy in patients with NIDDM. Family size was unlikely to have influenced the results because diabet ic cases had significantly fewer first-degree relatives than did diabe tic controls. Familial clustering of ESRD is present in certain Africa n-American families with NIDDM. Differences in family size and degree of diabetic control are unlikely to account for the differences observ ed between families. As in the Pima Indians, susceptibility to ESRD in African-Americans appears to be independent of the presence of NIDDM. These data strongly suggest that a genetic predisposition to renal di sease is present in these families, although shared environment cannot be excluded from contributing to this risk. (C) 1995 by the National Kidney Foundation, Inc.