French National Cohort MATRIX "Renal and Systemic Thrombotic Microangiopathy"

Sponsor

University Hospital, Tours (Other)

Overall Status

Recruiting

CT.gov ID

NCT05991245

Collaborator

(none)

1,000

Enrollment

Location

Anticipated Duration (Months)

41.6

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

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).

Condition or Disease	Intervention/Treatment	Phase
Thrombotic Microangiopathy Acute Kidney Injury Hemolytic Uremic Syndrome Nephrology Kidney Diseases	Other: Collecting datas

Detailed Description

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).

Study Design

Study Type:

Observational

Anticipated Enrollment :

1000 participants

Observational Model:

Cohort

Time Perspective:

Retrospective

Official Title:

French National Cohort MATRIX "Renal and Systemic Thrombotic Microangiopathy"

Actual Study Start Date :

Jan 1, 2023

Anticipated Primary Completion Date :

Jan 1, 2025

Anticipated Study Completion Date :

Jan 1, 2025

Arms and Interventions

Arm	Intervention/Treatment
MATRIX Thrombotic microangiopathy with kidney biopsy	Other: Collecting datas Blood, Tissue and Urine samples

Arm

Intervention/Treatment

MATRIX

Thrombotic microangiopathy with kidney biopsy

Other: Collecting datas

Blood, Tissue and Urine samples

Outcome Measures

Primary Outcome Measures

Presence of isolated renal, hematological or renal associated with hematological features ot thrombotic microangiopathies [1/ Baseline, ie date of kidney biopsy]
Clinical data

Secondary Outcome Measures

Assess correlations between specific anatomopathological lesions and thrombotic microangiopathies phenotypes [1/ Baseline, ie date of kidney biopsy]
Pathological and clinical data
Assess correlations between cause of thrombotic microangiopathies and clinical phenotypes [1/ Baseline, ie date of kidney biopsy]
Clinical data
Define the biological profile (standard biology and alternative complement pathway analyses including genetic data) of these thrombotic microangiopathies. [1/ Up to 2 weeks after baseline date ; 2/ Date of last follow-up, an average of 2 years]
Biological data
Define the renal, cardiovascular and vital prognosis of these patients [1/ Hospital discharge date, an average of 2 weeks ; 2/ Date of last follow-up, an average of 2 years]
Clinical data
Define treatments for these patients [1/ Hospital discharge date, an average of 2 weeks]
Clinical data

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Adult patients 18 years of age or older
Who have undergone renal biopsy of the native kidney for impaired renal function between 2009 and July 2022.
Presence of classically defined systemic MAT (most of the following parameters: elevated LDH, decreased haptoglobin, schizocytes, thrombocytopenia and anemia) AND/OR presence of arteriolar or glomerular renal MAT as indicated by the pathologist (including endothelial turgor, mesangiolysis, double contours, presence of thrombi, fibrinoid necrosis of the arterial wall).