*Purpose: Advances in next generation gene sequencing has made evaluation of genes associated with kidney easily accessible in the clinical settings. Renasight testing analyzes over 380 genes associated with disorders linked to kidney disease with greater than 99% detection rates across genes screened. The purpose of our study was to utilize Renasight genetic testing in the kidney transplant setting to correctly identify the etiology of end stage kidney disease in individuals with an unclear etiology.

*Methods: The testing was performed under both both Pre and Post transplant settings. Criteria used to test individuals for Renasight : Family history of ESRD, Atypical presentations of ESRD, Young individuals with ESRD of unclear etiology

*Results: Of 342 patients tested:17.5% (60) were positive for variants in at least one gene, 26 different genes were positive, 0.3%, patient had positive variants in more than one gene. Variants of Unknown significance genes were identified in 90% (309) patients. Test results resulted in further referrals, and evaluations and also identified oncogenes (RET mutation) COL4A3 and Apol1 were the most commonly identified diagnosis .

*Conclusions: Our study concludes that Renasight testing can help uncover the etiology of end stage renal disease patients in the transplant setting. These findings are likely to have implications not only in the management of the kidney transplant recipients, but also for potential donors when the etiology of ESRD in the recipient is unclear.

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