Dogma, a principle laid down by authorities as incontrovertibly true, is difficult to change once proven incorrect. Considering chronic kidney disease (CKD) in African Americans, the dogma that nearly 40% have mild-moderate hypertension as the cause of nephropathy, low-level proteinuria excludes glomerular disease, and focal segmental glomerulosclerosis is a nonspecific pathology was suddenly struck down with discovery of association between the apolipoprotein L1 gene (APOL1) and nondiabetic CKD. 1 Hypertension-attributed nephropathy: what's in a name?.

Nat Rev Nephrol. 2016; 12: 27-36

,2 Skorecki K.L. Wasser W.G. Hypertension-misattributed kidney disease in African Americans.

Kidney Int. 2013; 83: 6-9

APOL1 G1 and G2 kidney-risk variants (KRVs) display the strongest genetic association in complex disease; G0 is nonrisk. KRVs are found virtually only in populations with recent African ancestry and provide protection from African sleeping sickness. 3 Genovese G. Friedman D.J. Ross M.D. et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans.

Science. 2010; 329: 841-845

Possessing 2 KRVs, autosomal recessive inheritance (G1G1/G2G2/G1G2, 1 KRV from each parent) defines high-risk genotypes with markedly increased risk for CKD. Approximately 13% of African Americans possess 2 KRVs, and 87% have APOL1 low-risk genotypes (∼39% G0G1/G0G2; ∼48% G0G0). 3 Genovese G. Friedman D.J. Ross M.D. et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans.

Science. 2010; 329: 841-845