TTR and chronic kidney disease: Without therapy, 10% of Portuguese patients with ATTRV30M progressed to stage 5 CKD and one third had pathological albuminuria.36 In a study from France, comprising 21 different TTR gene mutations, one third of patients developed CKD and 20.3% had proteinuria.37 In both studies, late onset (as in this case) was associated with CKD.36,37 In the United States, Renasight testing applied for clinical purposes demonstrated that 4.1% of patients have a pathogenic TTR gene mutation, all with a V122I (p.Val142Ile) variant.38,39