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NCT Number: NCT06820866

Non-invasive Diagnosis of Idiopathic Nephrotic Syndromes

Renal biopsy (RB) is the reference diagnostic procedure for Idiopathic Nephrotic Syndrome (INS). It is an invasive procedure, particularly risky during the acute phase of nephrotic syndrome when anticoagulation therapy is required.

By identifying serum antibodies that allow for the non-invasive diagnosis of the main differential diagnoses of INS, (Membranous Nephropathy), the development of a non-invasive diagnostic tool for INS could help reduce the morbidity associated with the invasive renal biopsy procedure, minimizing the risk of incorrect diagnosis. We developed a diagnostic score, the SNIT, from routine clinical and biological variables to allow INS diagnoses in patients for whom detection of blood antibodies of Membranous Nephropathy were negative. The main goal of this study is to validate this diagnosis score in a prospective study, to allow INS diagnosis without renal biopsy.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

About this study

Medical management will not be altered by the protocol, and patients will be treated according to the practices of each center.

The investigator will offer participation in the study to all eligible consecutive patients in their center. They will provide an information sheet and answer any questions the patient may have. After obtaining the patient's non-opposition, the following clinical and biological data will be collected:

(Age, sex, medical and surgical history, BMI at admission, systolic and diastolic blood pressure at admission, presence of lower limb edema, CBC, blood electrolyte levels, urea, creatinine, albumin levels, urinary electrolytes, proteinuria, albuminuria, urine culture, antinuclear antibodies, serum protein electrophoresis, serum protein immunofixation, complement fractions C3 and C4, lipid profile).

The SNIT calculation will be performed automatically in the CRF from the variables it comprises, but will not be visible to the investigator.

As part of patient care, patients will be followed up one month after inclusion. During this visit, the evolving biological data (creatinine, albumin levels, proteinuria, albuminuria) and the treatment administered will be collected from the patient's medical records.

The final diagnosis will be collected as soon as it is available (within a maximum of 4 months for the completion and reporting of the histopathological results). Histological data will be collected from the report of the pathologist who examined the renal biopsy (available in the medical record). (In the case of INS: presence or absence of segmental and focal hyalinosis lesions, percentage of fibrosis).

The objectives of this study will be :

  • Evaluate the diagnostic performance of SNIT compared to renal biopsy (reference examination) for the diagnosis of Idiopathic Nephrotic Syndrome (INS)
  • Evaluate the other diagnostic parameters of the SNIT test.
  • Evaluate the avoidable costs
  • Evaluate the theoretical risks of a misdiagnosis of INS (through diagnostic delay and its consequences, as well as the risk of unnecessary corticosteroid treatment).

Duration of participant involvement and study duration:

The inclusion period will be 24 months. The follow-up period for participants will be a maximum of 4 months (until the histological diagnosis is returned). Therefore, the total duration of the research will be a maximum of 28 months.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients aged 18 years and older
  • Hospitalized for a first episode of nephrotic syndrome (proteinuria greater than 3g/g and albumin level < 30g/L)
  • Negative anti-PLA2r antibodies in the blood
  • Requirement for a renal biopsy for diagnostic purposes

Exclusion criteria

  • Patients with known lupus nephropathy (prior to the current episode)
  • Patients with known IgA nephropathy (prior to the current episode)

Treatment and study plan

Primary outcomes

  1. The sensitivity and specificity of the SNIT score (threshold = 0.36) and their 95% confidence interval

    Time frame: 4 months

Secondary outcomes

  1. Proportion of biopsies avoided with the use of SNIT. Proportions of diagnostic errors. Negative and positive predictive values and likelihood ratios of SNIT.

    Time frame: 4 months

  2. Avoidable costs: costs of biopsies, impact on nephrology services.

    Time frame: 4 months

  3. Estimation of the number of hospitalization days with the use of SNIT, and comparison with the actual number of hospitalization days.

    Time frame: 4 months

    The theoretical number of hospitalization days with the use of SNIT (i.e., estimated from the CRH data, subtracting the days of hospitalization required for renal biopsy in the case of a positive test).

    Adverse effects of corticosteroid treatment: infections, edema syndrome, corticosteroid-induced diabetes, heart failure decompensation.

Study contacts

Contact information is provided by the study sponsor or research team.

Alexandre LAHENS, Dr

CONTACT

[email protected]

+33 1 56 01 70 43

Jean-Jacques BOFFA, Pr

CONTACT

[email protected]

+33 1 56 01 60 29

Sponsors and collaborators

Lead sponsor

Assistance Publique - Hôpitaux de Paris

Other

Registry information

Official study title

Non-invasive Diagnosis of Idiopathic Nephrotic Syndromes : DNI-SNI

Acronym: DNI-SNI

Important dates

Study start
2025
Primary completion
2027
Study completion
2027
First posted
Feb 11, 2025
Registry last updated
Aug 14, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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