Why is there so much end-stage renal failure of undetermined cause in UK Indo-Asians?

There is a high incidence of end-stage renal failure (ESRF) of undetermined cause in the Indo-Asian population of the UK. We studied patients presenti ng from the district of Brent and Harrow, which has a large Indo-Asian comm unity, and whose renal services are largely provided by our centre. The dia gnosis and ethnicity of patients starting renal replacement therapy and/or undergoing renal biopsy were collated. The incidences of ESRF, rates of ren al biopsy and underlying diagnoses were calculated for Indo-Asians and Cauc asians. Requirement for renal replacement therapy in Indo-Asians presenting to our centre from Brent and Harrow was 221/10(6)/year; no underlying diag nosis was identified in 77/10(6)/year. Renal biopsy rate in these patients was 456/10(6)/year, and the diagnostic categories significantly over-repres ented compared to Caucasians were: hypertension and ischaemia, focal segmen tal glomerulosclerosis (FSGS), idiopathic interstitial nephritis (IIN), dia betic nephropathy, minor glomerular abnormality, lupus nephritis and non-sp ecific advanced chronic renal disease (p<0.001). The first three of these h ad a combined incidence of 135/10(6)/year in Indo-Asians and 31/10(6)/year in Caucasians. ESRF of undetermined cause is common in UK Indo-Asians, as i s requirement for renal biopsy. Hypertension with ischaemia, FSGS and IIN a re over-represented in the Indo-Asian population, and should be targeted fo r early diagnosis and treatment in this group.