a mixture of genetic influences that include African ancestry resulting in a prevalence of the APOL1 variants as well. Studies have also determined the prevalence of each individual allele in FSGS cases as well. Focal segmental glomerulosclerosis (FSGS) The prevalence of the G1 risk allele in African Americans with FSGS is 52% and 18-23% in those without FSGS. The prevalence of the G2 risk allele in African Americans with FSGS is 23% and 15% in those without FSGS. FSGS is a kidney disease that affects younger individuals therefore, its effects are slightly different from the effects of general non-diabetic ESKD. In a recent study, the mean ages of onset of FSGS for African Americans with 2, 1, and 0 APOL1 risk alleles was 32yrs, 36yrs and 39yrs, respectively. APOL1 variants also have a tendency to manifest FSGS at relatively young ages; FSGS begins between the ages of 15 to 39 in 70% of individuals with two APOL1 risk alleles and 42% of individuals with of 0 or 1 risk alleles. Pathogenesis Although possession of the APOL1 risk variants increases susceptibility to non-diabetic kidney disease, not all people who possess these variants develop kidney disease, which indicates another factor may initiate progression of kidney disease. Similarly in HIV positive patients, although the majority of African-American patients with HIVAN have two APOL1 risk alleles other as yet unknown factors in the host, including genetic risk variants and environmental or viral factors, may influence the development of this disorder in those with zero or one APOL1 risk allele. Kidney Int. 2012 Aug;82(3):338-43. The African American population has a total lifetime risk of developing FSGS of 0.8%. For those with 0 risk alleles the risk of developing FSGS is 0.2%, 0.3% with 1 risk allele, 4.25% with 2 risk alleles and a 50% chance of developing HIVAN for untreated HIV infected individuals. People with these allelic variants who develop ESKD begin dialysis at an earlier age than ESKD patients without the risk alleles. On average, those with two risk alleles begin dialysis approximately 10 years earlier than ESKD patients without the risk variants. The mean ages of initiation of dialysis of African American ESKD patients with two risk alleles, one risk allele, or no risk alleles are approximately 48yrs, 53yrs, and 58 yrs, respectively. Compared to African American ESKD patients, Hispanic ESKD patients with two APOL1 risk variants start dialysis at an earlier age,