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Many disease-associated variants can also be identified in the unaffected population, and the degree of enrichment in affected persons informs on the variant-associated risk. Whereas some variants have virtually complete penetrance, conforming to the old binary paradigm, others are just mildly enriched and thus may explain only part of the etiology. Moreover, the traditional paradigm of rare variants causing rare diseases, while common variants affect common disorders is changing as we recognize that rare variants constitute most of the overall genetic variation and thus contribute a much higher proportion of the heritability of common disorders than previously thought. Conversely, examples are emerging of common variants that contribute to rare recessive disorders. These insights from population genetics not only inform variant interpretation but also affect genetic counseling, especially if testing was conducted in a clinically unaffected individual, for instance in the context of cascade screening in the family of an affected relative. Depending on the variant-specific associated disease risk, a genetic testing result may not allow a clear distinction between affected and unaffected but only a prediction of the risk for developing the associated disease.<\/jats:p>","DOI":"10.1681\/asn.0000000893","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T16:00:27Z","timestamp":1757606427000},"page":"361-369","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Fifty Shades of Risk"],"prefix":"10.1681","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7753-0662","authenticated-orcid":false,"given":"Omid","family":"Sadeghi-Alavijeh","sequence":"first","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, University College London, London, United 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