Validation, Implementation, and Cost-analysis of a Strategy for Personalized Diagnosis of Rare Kidney Diseases

Not Applicable

Recruiting

• Conditions: Chronic Kidney Diseases
• Interventions: Diagnostic Test: Implementation of the diagnostic algorithm

• Registration Number: NCT06324136
• Lead Sponsor: Meyer Children's Hospital IRCCS

Brief Summary

Chronic kidney disease (CKD) affects about 10% of the world population, with high morbidity and mortality. Genetic kidney diseases are increasingly recognized across all age groups and represent over 20% of all the causes of CKD. Accurate diagnosis allows necessary and unnecessary diagnostic procedures to be defined, avoids unnecessary treatments, improves prognosis prediction, identifies other family members for genetic counseling, and defines risks for living donor kidney transplantation. The research group coordinated by the Principal Investigator has recently developed an algorithm for the genetic diagnosis in pediatric and adult patients with CKD. The application of this personalized diagnostic algorithm on a local study led to a global diagnostic yield of 70%, suggesting that this strategy has the potential to substantially improve the diagnostic approach to patients with rare kidney disorders. The aim of this study is to validate and implement these results by extending its application in a multicentric study involving nephrology units that are referral centers for rare kidney diseases at national level.

Detailed Description

Not available

Study Timeline

• Study Start: 2023-07-06
• Status Verified: 2024-03
• Study First Submitted: 2024-03-01
• Study First Submitted QC: 2024-03-15
• Last Update Submitted: 2024-03-15
• Study First Posted: 2024-03-21
• Last Update Posted: 2024-03-21
• Primary Completion: 2026-07-31
• Study Completion: 2026-12-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 300

Inclusion Criteria

• proteinuria and/or hematuria in the absence of immune deposits on renal biopsy or immune-mediated glomerulopathy resistant to treatment (e.g., steroids, immunosuppressive drugs);
• family history of kidney diseases and/or consanguinity;
• extrarenal involvement;
• ultrasound evidence of at least two cysts in each kidney or hyperechogenic kidneys or nephrocalcinosis;
• persistent metabolic abnormalities (metabolic acidosis or alkalosis without kidney function impairment; calcium phosphate metabolism abnormalities) after exclusion of secondary causes;
• availability of clinical information.
• signed informed consent form

Exclusion Criteria

• Refusal by the patient, parents, or legal guardian to provide informed consent.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Rare kidney diseases	Implementation of the diagnostic algorithm	Patients with rare kidney diseases

Primary Outcome Measures

Name	Time	Method
Implementation of a diagnostic algorithm for personalized diagnosis of rare kidney diseases	From enrollment of the first patient until the end of the study (up to 24 months)	The previously established diagnostic algorithm for rare kidney diseases will be extended to out-of-region centers with a multicenter study design.; This outcome will be assessed as diagnostic rate of the algorithm, i.e., number of conclusive genetic diagnosis/number of patients enrolled.

Secondary Outcome Measures

Name	Time	Method
Identification of immunological and/or structural factors in genetic and nongenetic forms.	Form enrollment until the last follow up visit (up to 12 months)	Identification of immunological and/or structural factors in genetic and nongenetic forms.; In particular, the investigators will assess: - the presence of anti-nephrin antibodies on serum samples and/or kidney biopsy of patients (performed for diagnostic purposes)
Analysis of the functional role of variant of unknown clinical significance (VUS)	Form enrollment until the last follow up visit (up to 12 months)	Analysis of the functional role of VUS identified by WES by in vitro functional studies and 3D-organ-on-a-chip models obtained by patients-specific urine-derived renal progenitor cells (u-RPC) cultures
Cost-effectiveness of the diagnostic algorithm.	From enrollment of the last patient until the end of the study (up to 24 months)	A modeled cost-effectiveness analysis (including direct and indirect medical costs) will be performed to compare the proposed diagnostic algorithm with the current standard-of-care.

Trial Locations

Locations (3)

Azienda Ospedaliero Universitaria Vanvitelli; 🇮🇹 Napoli, Italy

Meyer Children's Hospital IRCCS; 🇮🇹 Firenze, Italy

Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone; 🇮🇹 Palermo, Italy