- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06416761
Genetics in the Progression of Nephropathies
The Genetic Contribution to Progression of Kidney Disease
This study evaluates the role of genetic in the development and progression of different nephropaties with particular attention to:
- AKI
- CKD
- Hypertension
- ADPKD
- CKD-MBD
- Patients with decompensated heart failure undergoing either medical or surgery therapy
- Patients with hematologic cancer exposed to chemotherapeutic agents or undergoing allogeneic bone marrow transplantation
- glomerular diseases
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: In the past ten years there's been a progressive increase in the prevalence of CKD and consequently in the number of dialysed patients (~4% per year) in Italy. This is probably due to the increasingly ageing population and incidence of CV disease (cf. Lombardy Register). To date, diabetes and CV disease are the most common cause of end-stage renal disease (ESRD) requiring RRT. Nonetheless, intrinsic renal diseases still remain an important cause of CKD. In the past few years, various environmental factors have been identified that affect the clinical progression of kidney disease: blood pressure control, lipid and glycemic profile (expecially in the setting of diabetic nephropaty), uric acid level and acid-base homeostasis. Recently, there have been found some genes responsible for monogenic hereditary diseases such as ADPKD (PKD1 e PKD2) and Alport syndrome (COL4A3/COL4A4/COL4A5). It is known that there's an important phenotypic heterogeneity among different patients with the same disease even in the same family because of incomplete penetrance [5]. Furthermore, it is well known that familiarity overbear all other risk factors in predicting the development of hypertension and its progression toward CKD. Many scientific findings show the link between some genetic polymorphisms (e.g ACE, adducin) and disease severity or development of various complications. There is now, increasingly scientific evidence that genetic palys an important role even in the development and progression of multifactorial renal disease with both protective or promoting possible pathways. Thus, It would seem that interactions between environmental and genetic factors are responsible for disease phenotypic heterogeneity and its progression.
Aim of the study:
- Extend the knowledge on genetic modifiers involved in disease progression to better classify patients in homogeneous groups based on aetiology and concomitant risk factors. According to the underlying pathology, patients will be assessed either alone or with their family to evaluate the phenotypic heterogeneity.
- Evaluate the role of drugs that targets genetic or environmental factors.
- Assess the role of gentic background in the development of CV complications in CKD patients undergoing dyalisis.
- Assess the role of immature progenitor cells in the progression of kidney disease.
- Evaluate the role of endogenous Ouabain to identify at increased risk for AKI: 1) Postoperative patients. 2) patients with decompensated heart failure undergoing surgery or PCI. 3) patients with severe hypovolemic shock due to either cardiologic causes (e.g AMI) or from other causes (e.g sepsis, hypertensive crisis) 4) patients with hematologic cancer exposed to chemotherapeutic agents or undergoing allogeneic bone marrow transplantation.
- Identify the presence of genetic modifiers influencing the development and progression of CKD.
- Evaluate the role of genetic polymorphism in the transition from hypertension to kidney disease.
- Assess the role of salt intake in BP control and CKD progression either alone or in the presence of genetic modifiers.
- Evaluate the role of protein intake restriction in CKD progression eitehr alone or in the presence of genetic modifiers.
- Identify cortical bone lesions in CKD
- Assess the role of genetic, nutritional and biochemical factors involved in the cortical bone development
- Evaluate the role of genetic in the development of hypertension in patients who received allogenic bone marrow transplantation.
The genetic polymorphisms that will be considered, based on current knowledge are:
- Alpha, beta, gamma Adducin (ADD1, ADD2, ADD3),
- Renin Angiotensin System (RAAS),
- Glomerular proteins: nephrine, podocin, cadherin.
- Renal tubular transport systems (Na-Cl cotransport, Na channel, lithium, Cl channel, K channel, Ca channel, Amino Acids, specialized tubular transporters ouabain, drugs, digoxin, aquaporins, ANP, BNP).
- Genes linked to the metabolism and function of endogenous ouabain (eg LSS) and Klotho (eg KL).
- Polycystin 1, polycystin 2 (PKD1 and PKD2), uromodulline, S. di Alport (COL4A3/COL4A4/COL4A5)
For the study of any further genetic polymorphisms, additional amendments to this research protocol will be formulated.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Chiara Livia Lanzani, prof
- Phone Number: +393408163279
- Email: lanzani.chiara@hsr.it
Study Contact Backup
- Name: Laura Zagato, biologist
- Phone Number: +390226435745
- Email: zagato.laura@hsr.it
Study Locations
-
-
-
Milan, Italy, 20132
- Recruiting
- IRCCS Ospedale San Raffaele
-
Contact:
- Chiara Lanzani, MD
- Phone Number: +390226433891
- Email: lanzani.chiara@hsr.it
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
This study will evaluate different groups of adult patients:
- Patients with chronic nephropathy
- Patients with acute nephropathy
- Patients with nephrectomy
- Candidate Patients to major surgery
- Patients with decompensated heart failure undergoing either medical or surgical therapy
- Acute critically ill patients (e.g sepsis, post-operative)
- Patients with hypertension
- Patients with hematologic cancer exposed to chemotherapeutic agents or undergoing allogeneic bone marrow transplantation.
- Long-term surviving patients who received bone marrow transplantation.
Description
Inclusion Criteria:
. presence of specific renal disease
Exclusion Criteria:
- to be evaluated in the different sub-protocols
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Patients with acute or chronic nephropathy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
difference in glomerular filtration rate according to genetic profile
Time Frame: from days to 35 years
|
eGFR value
|
from days to 35 years
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Neoplasms
- Neoplasms by Site
- Urologic Diseases
- Disease Attributes
- Hematologic Diseases
- Renal Insufficiency
- Chronic Disease
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Hypertension
- Disease Progression
- Kidney Diseases
- Renal Insufficiency, Chronic
- Hematologic Neoplasms
Other Study ID Numbers
- GenNefro01
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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