Clinical Trial: European Alport Therapy Registry - European Initiative Towards Delaying Renal Failure in Alport Syndrome

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Observational [Patient Registry]

Official Title: European Alport Therapy Registry - European Initiative Towards Delaying Renal Failure in Alport Syndrome: Current and Novel Therapies

Brief Summary: The hereditary type IV collagen disease Alport syndrome inevitably leads to end-stage renal disease. Currently there are no therapies known to improve outcome. Our non-interventional, observational study investigates, if medications such as ACE-inhibitors can (1) delay time to dialysis and (2) improve life-expectancy within three generations of Alport-families in Europe.

Detailed Summary:

Early diagnosis in children with Alport syndrome (AS) with isolated hematuria opens a "window of opportunity" for early intervention. Currently there are no causal therapeutic options which are proven to delay renal failure in AS. ACE-inhibition (ACEi) has been shown to reduce proteinuria in Alport patients and to delay renal failure in Alport-mice suggesting it may be of value as an effective treatment to delay renal failure in humans. To test this we established the European Alport Registry to collect data over several generations of Alport families across Europe. Small children with AS first develop microscopic hematuria, proceeding to microalbuminuria, overt proteinuria, impaired renal function and end up with end stage renal disease. These different steps of disease enabled us to assess if earlier introduction of ACE-inhibition at earlier degrees of disease is more effective than later therapy in delaying the time to dialysis and improving life-expectancy.

Heterozygous COL4A3/COL4A4 mutations result in the phenotype "familial benign hematuria" or "thin basement membrane nephropathy" (TBMN). Affected subjects typically present with hematuria. Having longtime been regarded as "benign" familial hematuria, those patients might have an increased risk to develop severe renal impairment - comparable to the findings in female XLAS carriers (see above). TBMN is not a rare disease, as at least 1% of the population is affected.

For the first time, the present study compares the risk of renal impairment, end stage renal disease and premature death in between heterozygous carriers of XLAS and of ARAS mutations. Additionally, the nephroprotective effect of RAAS-blockade in patients with heterozygous Alport-mutations is evaluated.


Sponsor: University Hospital Goettingen

Current Primary Outcome:

  • end stage renal disease [ Time Frame: unlimited ]
    Age at onset of end stage renal failure
  • life-expectancy [ Time Frame: unlimited ]
    life-expectancy of patients and carriers


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • proteinuria after initiation of ACE-inhibitor-therapy [ Time Frame: unlimited ]
  • proportion of patients with a clinical diagnosis of hypertension [ Time Frame: unlimited ]
  • proportion of patients experiencing side effects from ACE-inhibitors [ Time Frame: unlimited ]
    defined as acute renal failure (doubling of serum-creatinine), angioedema, hyperkalemia >5.0 mmol/l, dry cough, symptomatic hypotension (orthostatic collapse) and others, and death from all causes.


Original Secondary Outcome: Same as current

Information By: University Hospital Goettingen

Dates:
Date Received: February 26, 2015
Date Started: July 1995
Date Completion: July 2019
Last Updated: October 24, 2016
Last Verified: October 2016