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Predicting the outcome of human renal diseases by gene expression profiling: myth or reality?

All over the world millions of people are affected by chronic renal failure, leading to immense suffering and an increasing economic burden. In 1998, the number of patients with end-stage renal failure (ESRF) was approximately 600,000 in the European Union and the United States1,2. It is anticipated that this number will double by the end of 2010. The incidence of ESRF is indeed being augmented by an annual rate of 6% to 8% due to a dramatic increase in the number of patients with type 2 diabetes and vascular diseases, and to the increasing age of the population. Dialysis will remain the only option for the majority of the patients because the supply of donor organs for transplantation is so limited, and because many patients are now no longer suitable for transplantation because of age and deteriorated condition. It has been calculated that a 30% reduction in the rate of decline of renal function in patients with moderate-to-severe renal failure would translate into cumulative direct health care savings of more than $60 billion dollars by the year 2010 in the United States3. This emphasizes the urgent need to minimize the number of people developing chronic renal failure (CRF), and this can only be achieved by more effective treatment of the diseases that cause it.