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2017 ; 32
(2
): 325-332
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Genetic risk variants for membranous nephropathy: extension of and association
with other chronic kidney disease aetiologies
#MMPMID27333618
Sekula P
; Li Y
; Stanescu HC
; Wuttke M
; Ekici AB
; Bockenhauer D
; Walz G
; Powis SH
; Kielstein JT
; Brenchley P
; Eckardt KU
; Kronenberg F
; Kleta R
; Köttgen A
Nephrol Dial Transplant
2017[Feb]; 32
(2
): 325-332
PMID27333618
show ga
BACKGROUND: Membranous nephropathy (MN) is a common cause of nephrotic syndrome
in adults. Previous genome-wide association studies (GWAS) of 300 000 genotyped
variants identified MN-associated loci at HLA-DQA1 and PLA2R1. METHODS: We used a
combined approach of genotype imputation, GWAS, human leucocyte antigen (HLA)
imputation and extension to other aetiologies of chronic kidney disease (CKD) to
investigate genetic MN risk variants more comprehensively. GWAS using 9 million
high-quality imputed genotypes and classical HLA alleles were conducted for 323
MN European-ancestry cases and 345 controls. Additionally, 4960 patients with
different CKD aetiologies in the German Chronic Kidney Disease (GCKD) study were
genotyped for risk variants at HLA-DQA1 and PLA2R1. RESULTS: In GWAS, lead
variants in known loci [rs9272729, HLA-DQA1, odds ratio (OR) = 7.3 per risk
allele, P = 5.9 × 10(-27) and rs17830558, PLA2R1, OR = 2.2, P = 1.9 × 10(-8)]
were significantly associated with MN. No novel signals emerged in GWAS of
X-chromosomal variants or in sex-specific analyses. Classical HLA alleles
(DRB1*0301-DQA1*0501-DQB1*0201 haplotype) were associated with MN but provided
little additional information beyond rs9272729. Associations were replicated in
137 GCKD patients with MN (HLA-DQA1: P = 6.4 × 10(-24); PLA2R1: P = 5.0 ×
10(-4)). MN risk increased steeply for patients with high-risk genotype
combinations (OR > 79). While genetic variation in PLA2R1 exclusively associated
with MN across 19 CKD aetiologies, the HLA-DQA1 risk allele was also associated
with lupus nephritis (P = 2.8 × 10(-6)), type 1 diabetic nephropathy (P = 6.9 ×
10(-5)) and focal segmental glomerulosclerosis (P = 5.1 × 10(-5)), but not with
immunoglobulin A nephropathy. CONCLUSIONS: PLA2R1 and HLA-DQA1 are the
predominant risk loci for MN detected by GWAS. While HLA-DQA1 risk variants show
an association with other CKD aetiologies, PLA2R1 variants are specific to MN.