At this point we do not know whether anti-KIR autoantibodies have a causative role in the development of nephritis or whether they represent an epiphenomenon, but it is interesting to note that a study of 512 patients with end-stage renal disease (ESRD) due to chronic glomerulonephritis, chronic interstitial nephritis, hypertensive nephrosclerosis or diabetic nephropathy and 512 healthy controls found a larger proportion of individuals with less educated NK cells in patients with ESRD (i.e., negative for either KIR2DL1/HLA-C2, KIR2DL2/HLA-C1, or KIR3DL1/HLA-Bw4) (49). This evidence concerns the gene KIR3DL1 and diabetic kidney disease.