Why is there so much end‐stage renal failure of undetermined cause in UK Indo‐Asians?

There is a high incidence of end‐stage renal failure (ESRF) of undetermined cause in the Indo‐Asian population of the UK. We studied patients presenting from the district of Brent and Harrow, which has a large Indo‐Asian community, and whose renal services are largely provided by our centre. The diagnosis and ethnicity of patients starting renal replacement therapy and/or undergoing renal biopsy were collated. The incidences of ESRF, rates of renal biopsy and underlying diagnoses were calculated for Indo‐Asians and Caucasians. Requirement for renal replacement therapy in Indo‐Asians presenting to our centre from Brent and Harrow was 221/106/year; no underlying diagnosis was identified in 77/106/year. Renal biopsy rate in these patients was 456/106/year, and the diagnostic categories significantly over‐represented compared to Caucasians were: hypertension and ischaemia, focal segmental glomerulosclerosis (FSGS), idiopathic interstitial nephritis (IIN), diabetic nephropathy, minor glomerular abnormality, lupus nephritis and non‐specific advanced chronic renal disease ( p <0.001). The first three of these had a combined incidence of 135/106/year in Indo‐Asians and 31/106/year in Caucasians. ESRF of undetermined cause is common in UK Indo‐Asians, as is requirement for renal biopsy. Hypertension with ischaemia, FSGS and IIN are over‐represented in the Indo‐Asian population, and should be targeted for early diagnosis and treatment in this group.