APOL1 Variant and Kidney Disease

To the Editor The authors of “APOL1-Mediated Kidney Disease” have provided an invaluable road map for identifying the link between the G1 and G2 APOL1 variants and high risk of “hypertension-attributed ESKD, lupus nephritis–attributed ESKD, FSGS, and HIV-associated nephropathy” in Black individuals. While the authors have identified the function of these gene variants as an immune response to trypanosomiasis (sleeping sickness), there is a critical missing piece to this puzzle. The G1 and G2 APOL1 variants are also highly sodium retentive.