Evaluation of a Screening Strategy of Fabry Disease in Patient With Renal Biopsy

Renal Disease Clinical Trial

— HISTOFAB  

Official title:

Evaluation of a Screening Strategy of Fabry Disease in Patient With Renal Biopsy: Histo-Fab Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03869554
• Other study ID #: 49RC19_0032
• Status: Recruiting
• Phase: N/A
• Start date: February 3, 2020
• Est. completion date: August 2, 2025

Study information

• Verified date: June 2024
• Source: University Hospital, Angers
• Contact: Jean-François AUGUSTO
• Phone: 02 41 35 82 02
• Email: jfaugusto[@]chu-angers.fr
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Fabry disease is genetic X linked disease, with annual incidence of 1 in 100,000 that is certainly underestimate the true prevalence of the disease.

Renal biopsy in some patients does not allow determining the etiology of nephropathy. It is why investigators would like to evaluate the screening of Fabry patients from renal biopsy in patient with idiopathic nephropathy.

Investigator hypothesize to detect one or more cases of patients with Fabry disease in local idiopathic nephropathy population with renal biopsy.

That would allow reviewing and optimizing the target screening for Fabry Disease. The purpose would be to detect Fabry disease systematically in patients presenting a nephropathy of undetermined etiology in spite of the renal biopsy or presenting nonspecific histological characteristics.

In Fabry disease with renal impairment, proteinuria is the first sign, usually occurring in the second decade. The evolution is progressively towards end-stage renal failure during the fourth decade. The presence of renal impairment is globally associated with a poor prognosis.

Renal histology can be used to diagnose Fabry disease by revealing sphingolipid deposits identified by optical microscopy in the form of vacuoles in podocytes, distal tubule epithelial cells or in the media of the distal tubules. vascular walls. Resin inclusion with Toluidine blue staining is the staining of choice for visualizing lipid inclusions. However, this staining is not used as a first intention in routine. On the paraffin-fixed tissues, the vacuoles are less visible because they dissolve.

Thus, the renal histological analysis sometimes reveals only non-specific damage to the various structures of the kidney and may not allow identification of very evocative inclusions. Under the effect of oxidative stress induced by sphingolipid deposits, lesions of tubulo-interstitial fibrosis settle quite early. At the level of the glomerulus, glycosphingolipids lead to the production of angiotensin II and TGF-β leading to an excess production of constituents of the glomerular basement membrane inducing its thickening and glomerulosclerosis. Arteries of all sizes are also the seat of intimal thickening and media accelerating the process of intrarenal ischemia. These lesions, which may appear isolated or synchronous, and nonspecific, are sometimes in the foreground and do not point in the first line to the etiological diagnosis of Fabry disease.

Also, among the patients presenting a nephropathy of undetermined etiology in spite of the renal biopsy or presenting nonspecific histological characteristics, investigator propose to systematically detect the Fabry disease. Screening will be done in a selected population of renal biopsy patients using the dried blood spot kits.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: August 2, 2025
• Est. primary completion date: June 2, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult patient (> 18 years old)

• Obtaining consent to participate in the study

• Patients whose clinical presentation meets at least one of the following criteria:

• Undetermined nephropathy despite renal biopsy,

• Nephroangiosclerosis as the predominant lesion

• Chronic tubulointerstitial nephropathy,

• Glomerulosclerosis,

• Segmental and focal hyalinosis.

• Optically normal kidney or seat of minimal lesions

Exclusion Criteria:

• Patient who has already been screened for Fabry Disease

• At least one of the following criteria:

• Nephrotic syndrome and/or Glomerular nephropathy

• Histological diagnosis of certain nephropathies (specific kidney lesions)

Related Conditions & MeSH terms

• Fabry Disease
• Renal Disease

Intervention

Diagnostic Test:
• Detection of Fabry disease
Systematic detection of Fabry disease

Locations

Country	Name	City	State
France	CHU Angers	Angers

Sponsors (1)

Lead Sponsor	Collaborator
University Hospital, Angers

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Assess the value of screening for Fabry's disease in patients with kidney disease whose etiology remains undetermined after renal biopsy	number of patients diagnosed with Fabry's disease identified	1 month
Secondary	Estimate the prevalence of Fabry disease		12 months