New ideas about mechanism in APOL1 kidney disease.

Friedman, David J; Pollak, Martin R · Kidney Int · 2026

editorial · Level V

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Abstract

Apolipoprotein L1 risk variants contribute to high rates of kidney disease among individuals of African ancestry. These gain-of-function variants cause toxicity to kidney cells, but the mechanism of injury is not clear. Many theories have been proposed, yet the field has not arrived at a consensus. Kim et al. make a compelling argument for a peroxisomal pathway of injury specifically activated under hypoxic conditions. Introducing cellular context reframes the debate about apolipoprotein L1 mechanism of disease.

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