An observational study in Thrombotic Microangiopathy, Acute Kidney Injury and Hemolytic Uremic Syndrome, sponsored by University Hospital, Tours. Recruiting at 1 site in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-08-14.
Sponsored by University Hospital, Tours · Observational
Thrombotic microangiopathies (TMAs) are a diverse, rare but serious group of diseases. Progress has been made regarding the epidemiology of TMA (Bayer CJASN 2019). It has been shown that secondary TMAs account for 95% of cases, whereas primary TMAs (atypical hemolytic syndromes (HUS) and thrombotic thrombocytopenic purpura (TTP)) account for only about 5%.
However, in many cases, the pathophysiology, optimal management and prognosis of TMA remains unclear and it has been shown that patients with TMA may have renal-limited TMA or renal and hematological TMA (ie. With (mechanical anemia, thrombocytopenia, elevated LDH, decreased haptoglobin, schistocytes). In most studies, kidney biopsies are not performed and the diagnostic workup is uncomplete.
As this is a rare disease, only a multicenter approach (>20 centers) over a long period of time (>10 years), with adequate diagnostic workup including kidney biopsies can help us to answer these questions (investigators in the present are usually members of the CNR-MAT (a network of the TMA centers in France).
Thrombotic microangiopathies (TMAs) are a diverse, rare but serious group of diseases. Their epidemiology has recently been elucidated thanks to work published by our team. It has been shown that secondary TMAs account for 95% of cases, whereas primary TMAs (atypical hemolytic syndromes (HUS) and thrombotic thrombocytopenic purpura (TTP)) account for only about 5%.
However, many epidemiologic problems remain. First, many but not all patients with TMA as classically defined (mechanical anemia, thrombocytopenia, elevated LDH, decreased haptoglobin, schizocytes) have impaired renal function. If a renal biopsy is performed (which is not always the case, as TMA is a risk factor for bleeding after renal biopsy), the renal lesions do not always show "renal-limited" TMA. We also do not know which of the causes of systemic TMA are associated with renal TMA and which are not.
Conversely, in patients with renal biopsy, we can find stigmata of renal-limited TMA in the absence of systemic TMA. Why do some patients have systemic TMA but not renal TMA and others have renal TMA but not systemic TMA? Most studies are based on a few small clinical cases and the literature reviews that report them.
The vital, renal, and cardiovascular prognosis of patients with TMA obviously depends on the cause, the clinical presentation of the patients, and their management. However, the renal, systemic, and vital outcomes of renal-only vs. systemic-only vs. systemic and renal TMA, regardless of the cause and severity of TMA, are currently unknown.
As this is a rare disease, only a multicenter approach (>20 centers) over a long period of time (>10 years), including highly recruited university and general hospitals, with experienced and motivated investigators, can help us to answer these currently unanswered questions (these investigators usually belong to the competence centers of the national reference center).
28 studies on the registry are indexed under Hemolytic-Uremic Syndrome; 7 are open to participants now.
This study's planned enrollment of 1,000 is above the median of 50 across 13 observational studies indexed under Hemolytic-Uremic Syndrome.
Browse Hemolytic-Uremic Syndrome studies →University Hospital, Tours is the lead sponsor of 307 studies on the registry; 79 are open to participants now.
Compared within Hemolytic-Uremic Syndrome, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Thrombotic Microangiopathies. The counts are of registry records indexed under each term, refreshed daily. How we classify →
The population corresponds to French adult nephrology patients with renal and/or systemic thrombotic microangiopathy, for whom renal biopsy data are available. It is not extendable to renal transplant patients.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Biopsy and archival tissue
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Thrombotic microangiopathy with kidney biopsy
Other: Collecting datas
Blood, Tissue and Urine samples
Presence of isolated renal, hematological or renal associated with hematological features ot thrombotic microangiopathies
Clinical data
Time frame: 1/ Baseline, ie date of kidney biopsy
Assess correlations between specific anatomopathological lesions and thrombotic microangiopathies phenotypes
Pathological and clinical data
Time frame: 1/ Baseline, ie date of kidney biopsy
Assess correlations between cause of thrombotic microangiopathies and clinical phenotypes
Clinical data
Time frame: 1/ Baseline, ie date of kidney biopsy
Define the biological profile (standard biology and alternative complement pathway analyses including genetic data) of these thrombotic microangiopathies.
Biological data
Time frame: 1/ Up to 2 weeks after baseline date ; 2/ Date of last follow-up, an average of 2 years
Define the renal, cardiovascular and vital prognosis of these patients
Clinical data
Time frame: 1/ Hospital discharge date, an average of 2 weeks ; 2/ Date of last follow-up, an average of 2 years
Define treatments for these patients
Clinical data
Time frame: 1/ Hospital discharge date, an average of 2 weeks
Plan to share: Undecided
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