Genes and environment in chronic kidney disease hotspotsFriedman, David J.Current Opinion in Nephrology and Hypertension: January 2019 - Volume 28 - Issue 1 - p 87–96 doi: 10.1097/MNH.0000000000000470 SPECIAL COMMENTARIES Abstract Author InformationAuthors Article MetricsMetrics Purpose of review Chronic kidney disease (CKD) can cluster in geographic locations or in people of particular genetic ancestries. We explore APOL1 nephropathy and Balkan nephropathy as examples of CKD clustering that illustrate genetics and environment conspiring to cause high rates of kidney disease. Unexplained hotspots of kidney disease in Asia and Central America are then considered from the perspective of potential gene × environment interactions. Recent findings We report on evidence supporting both genes and environment in these CKD hotspots. Differing genetic susceptibility between populations and within populations may explain why causal environmental risk factors have been so hard to identify conclusively. Similarly, one cannot explain why these epidemics of kidney disease are happening now without invoking environmental changes. Summary Approaches to these CKD hotspots are of necessity becoming more holistic. Genetic studies may help us identify the environmental triggers by teaching us about disease biology and may empower environmental risk factor studies by allowing for stratification of study participants by genetic susceptibility. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA Correspondence to David J. Friedman, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. Tel: 1 617 667 0253; e-mail: email@example.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.