Previous studies, including the Chronic Kidney Disease in Children (CKiD) study cohort in the USA and the Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRI in PEdiatric Patients (ESCAPE) and the Cardiovascular Phenotypes in Children with CKD (4C) studies in Europe, have shown that early alterations in cardiovascular structure and function occur even before the need for renal replacement therapy [7–9]. The gene discussed is ACE; the disease is chronic kidney disease.