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Nephrotic Syndrome Study Network (NEPTUNE)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2016 by University of Michigan
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The NephCure Foundation
Information provided by (Responsible Party):
Matthias Kretzler, University of Michigan Identifier:
First received: July 29, 2010
Last updated: October 10, 2016
Last verified: October 2016

Minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and Membranous nephropathy (MN), generate an enormous individual and societal financial burden, accounting for approximately 12% of prevalent end stage renal disease (ESRD) cases (2005) at an annual cost in the US of more than $3 billion. However, the clinical classification of these diseases is widely believed to be inadequate by the scientific community. Given the poor understanding of MCD/FSGS and MN biology, it is not surprising that the available therapies are imperfect. The therapies lack a clear biological basis, and as many families have experienced, they are often not beneficial, and in fact may be significantly toxic. Given these observations, it is essential that research be conducted that address these serious obstacles to effectively caring for patients.

In response to a request for applications by the National Institutes of Health, Office of Rare Diseases (NIH, ORD) for the creation of Rare Disease Clinical Research Consortia, a number of affiliated universities joined together with The NephCure Foundation the NIDDK, the ORDR, and the University of Michigan in collaboration towards the establishment of a Nephrotic Syndrome (NS) Rare Diseases Clinical Research Consortium.

Through this consortium the investigators hope to understand the fundamental biology of these rare diseases and aim to bank long-term observational data and corresponding biological specimens for researchers to access and further enrich.

Minimal Change Disease (MCD)
Membranous Nephropathy
Glomerulosclerosis, Focal Segmental

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Nephrotic Syndrome Study Network Under the Rare Diseases Clinical Research Network

Resource links provided by NLM:

Further study details as provided by University of Michigan:

Primary Outcome Measures:
  • Event rate of change in urinary protein excretion and renal function. [ Time Frame: 60 months ]
    Defined as remission, partial remission and non-remission

  • Rate of change in renal function. [ Time Frame: 60 months ]

    Defined as:

    1. 25 mls/min/1.73m2 reduction in follow-up estimated GFR (using the 4-variable MDRD equation for ages ≥18 years and modified Schwartz for ages <18 years) compared to baseline estimated GFR
    2. 50% decline in follow-up estimated GFR compared to baseline measurement
    3. End stage renal disease defined as estimated GFR ≤10cc/min, initiation of maintenance dialysis or preemptive kidney transplantation.

Secondary Outcome Measures:
  • Quality of Life: [ Time Frame: 60 months ]
    Patient-reported outcome will be assessed using Quality of Life questionnaires at regular intervals as stipulated in the visit calendar using the SF-36, PedsQL and the Patient Reported Outcome Measurement Information System (PROMIS) (in the age-appropriate groups).

  • Malignancies [ Time Frame: 60 months ]
    Any cancer diagnosis of the skin, hematopoietic system, or solid organ after enrollment in NEPTUNE

  • Infections, Serious and Systemic [ Time Frame: 60 months ]

    Infections including one of the following:

    1. Documented diagnosis of infection of the skin or subcutaneous tissue (e.g. cellulitis), vascular system, peritoneum, or any vital organ requiring the use of parenteral antibiotics and/or oral antibiotics alone or in combination for a treatment interval of ≥72 hours.
    2. Hospitalization for treatment of infection

  • Thromboembolic Events [ Time Frame: 60 months ]

    Documented diagnosis of one of the following:

    1. Embolic cerebrovascular accident
    2. Deep venous thrombosis
    3. Renal vein thrombosis or
    4. Pulmonary embolus

  • Hospitalization [ Time Frame: 60 months ]
    Documented hospital admission, including observation for ≥24 hours.

  • Emergency Department/ Observation Unit Visit [ Time Frame: 60 months ]
    Documented visit to an emergency department or observation unit that does not lead to hospitalization and is less than 24 hours.

  • Acute Kidney Injury [ Time Frame: 60 months ]
    Documented diagnosis of acute kidney injury as defined by the AKIN (Mehta et al., Critical Care 2007, 11:R31) and/or renal failure requiring renal replacement therapy <3 months.

  • Death [ Time Frame: 60 months ]
    1. Documentation of death that is secondary to infection or sepsis.
    2. Cardiovascular/Cerebrovascular-related Death: Sudden death; Myocardial infarction; Congestive heart failure; Primary intractable serious arrhythmia; Peripheral vascular disease; Ischemic cerebrovascular accident; Hemorrhagic cerebrovascular accident; Thromboembolic event
    3. Documentation of death secondary to cancer
    4. Other Death: Documentation of death that does not fall into the above categories.

  • New Onset Diabetes [ Time Frame: 60 months ]

    Diagnosis of diabetes as indicated by 1 or more of the following not present at NEPTUNE Enrollment:

    1. Documented diagnosis of diabetes in medical record
    2. Casual (non-fasting) blood glucose > 200 mg/dL c) Fasting blood glucose > 126 mg/dL d) 2 hour glucose > 200 after oral glucose tolerance test e) chronic use (>6 mos) hypoglycemic therapy outside of pregnancy f) Hemogloblin A1C >= 6.5%

Biospecimen Retention:   Samples With DNA
Renal tissue core (from clinically indicated kidney biopsy procedure) Blood products Urine products DNA/RNA specimens (declining consent does not forego participant eligibility)

Estimated Enrollment: 600
Study Start Date: April 2010
Estimated Study Completion Date: June 2019
Estimated Primary Completion Date: June 2019 (Final data collection date for primary outcome measure)

Focal Segmental Glomerulosclerosis/Minimal Change Disease (FSGS/MCD) Cohort

Participants enrolled in NEPTUNE with a biopsy proven histological diagnosis for FSGS or MCD.

MN Cohort

Membranous Nephropathy (MN) Cohort

Enrolled participants, biopsy proven to have membranous nephropathy.

Other glomerulopathies cohort
Participants enrolled in NEPTUNE and determined to not have FSGS/MCD or MN will be followed in a third group.

Detailed Description:

Idiopathic Nephrotic Syndrome (NS) is a rare disease syndrome responsible for approximately 12% of all causes of end-stage kidney disease (ESRD) and up to 20% of ESRD in children. Treatment strategies for Focal and Segmental Glomerulosclerosis (FSGS), Minimal Change Disease (MCD) and Membranous Nephropathy (MN), the major causes of NS, include high dose prolonged steroid therapy, cyclophosphamide, cyclosporine A, tacrolimus, mycophenolate mofetil and other immunosuppressive agents, which all carry significant side effects. Failure to obtain remission using the current treatment approaches frequently results in progression to ESRD with its associated costs, morbidities, and mortality. In the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry, half of the pediatric patients with Steroid Resistant Nephrotic Syndrome required renal replacement therapy within two years of being enrolled in the disease registry. FSGS also has a high recurrence rate following kidney transplantation (30-40%) and is the most common recurrent disease leading to allograft loss.

The prevailing classification of Nephrotic Syndrome categorizes patients into FSGS, MCD, and MN, if in the absence of other underlying causes, glomerular histology shows a specific histological pattern. This classification does not adequately predict the heterogeneous natural history of patients with FSGS, MCD, and MN. Major advances in understanding the pathogenesis of FSGS and MCD have come over the last ten years from the identification of several mutated genes responsible for causing Steroid Resistant Nephrotic Syndrome (SRNS) presenting with FSGS or MCD histopathology in humans and model organisms. These functionally distinct genetic disorders can present with indistinguishable FSGS lesions on histology confirming the presence of heterogeneous pathogenic mechanisms under the current histological diagnoses.

The limited understanding of FSGS, MCD, and MN biology in humans has necessitated a descriptive classification system in which heterogeneous disorders are grouped together. This invariably consigns these heterogeneous patients to the same therapeutic approaches, which use blunt immunosuppressive drugs that lack a clear biological basis, are often not beneficial, and are complicated by significant toxicity. The foregoing shortcomings make a strong case that concerted and innovative investigational strategies combining basic science, translational, and clinical methods should be employed to study FSGS, MCD, and MN. It is for these reasons that the Nephrotic Syndrome Study Network is established to conduct clinical and translational research in patients with FSGS/MCD and MN.


Ages Eligible for Study:   up to 80 Years   (Child, Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Patients with signs and symptoms of kidney disease consistent with FSGS, MCD, MN or proteinuric renal disease or pediatric participants not previously biopsied, who present for patient care at the participating clinical centers will be eligible for Cohort A (biopsy cohort) study population targeted for enrollment into the NEPTUNE study. Potential participants willing to receive their biopsy care, and subsequent follow-up study visits at one of these sites are welcome to participate.

Additionally, to establish a cohort of pediatric participants with incident nephrotic syndrome, Cohort B, a non-biopsy cohort has been initiated for Protocol V4.0. This population, < 19 years of age, who present for nephrotic syndrome and have less than 30 days of immunosuppression therapy exposure, will also be targeted for enrollment into the cNEPTUNE study. Potential participants willing to receive follow-up care and study visits at one of these sites are also welcome to participate.


Cohort A (biopsy cohort) Inclusion Criteria:

Patients presenting with an incipient clinical diagnosis for FSGS/MCD or MN or pediatric participants not previously biopsied, with a clinical diagnosis for FSGS/MCD or MN meeting the following inclusion criteria:

  • Documented urinary protein excretion ≥1500 mg/24 hours or spot protein: creatinine ratio equivalent at the time of diagnosis or within 3 months of the screening/eligibility visit.
  • Scheduled renal biopsy

Cohort B (non-biopsy, cNEPTUNE) Inclusion Criteria:

  • Age <19 years of age
  • Initial presentation with <30 days immunosuppression therapy
  • Proteinuria/nephrotic

    • UA>2+ and edema OR
    • UA>2+ and serum albumin <3 OR
    • UPC > 2g/g and serum albumin <3

Exclusion Criteria (Cohort A&B):

  • Prior solid organ transplant
  • A clinical diagnosis of glomerulopathy without diagnostic renal biopsy
  • Clinical, serological or histological evidence of systemic lupus erythematosus (SLE) as defined by the ARA criteria. Patients with membranous in combination with SLE will be excluded because this entity is well defined within the International Society of Nephrology/Renal Pathology Society categories of lupus nephritis, and frequently overlaps with other classification categories of SLE nephritis (68)
  • Clinical or histological evidence of other renal diseases (Alport, Nail Patella, Diabetic Nephropathy, IgA-nephritis, monoclonal gammopathy (multiple myelomas), genito-urinary malformations with vesico-urethral reflux or renal dysplasia)
  • Known systemic disease diagnosis at time of enrollment with a life expectancy less than 6 months
  • Unwillingness or inability to give a comprehensive informed consent
  • Unwillingness to comply with study procedures and visit schedule
  • Institutionalized individuals (e.g., prisoners)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01209000

Contact: Chrysta C. Lienczewski, BS 1-877-9-NEPTUNE
Contact: Tina Mainieri, MS 1-877-9-NEPTUNE

  Hide Study Locations
United States, California
University of Southern California-Children's Hospital Recruiting
Los Angeles, California, United States, 90227
Contact: Sharon Tang, RN    323-361-7299   
Contact: Lisa Padilla, RN    323-361-7299   
Principal Investigator: Kevin Lemley, MD, PhD         
Stanford University School of Medicine Recruiting
Palo Alto, California, United States, 94304
Contact: Kshama Mehta, PhD    650-736-1822   
Principal Investigator: Richard Lafayette, MD         
Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center Recruiting
Torrance, California, United States, 90502
Contact: Janine LaPage    310-222-4104   
Principal Investigator: Sharon Adler, MD         
United States, Florida
University of Miami Miller School of Medicine Recruiting
Miami, Florida, United States, 33136
Contact: Allison Barchi-Chung    305-243-5870   
Principal Investigator: Alessia Fornoni, MD. PhD         
United States, Georgia
Emory University and Children's Healthcare of Atlanta Recruiting
Atlanta, Georgia, United States, 30322
Contact: Monica Haughton    404-785-0996   
Contact: Lu Arechiga, BS    404-727-0851   
Principal Investigator: Laurence Greenbaum, MD, PhD         
United States, Illinois
John Stroger Cook County Hospital Recruiting
Chicago, Illinois, United States, 60680
Contact: Ambarish Athavale, MBBS, DGO    312-864-4614   
Contact: Taha Iqbal, MS    312-864-4614   
Principal Investigator: Ambarish Athavale, MD         
United States, Maryland
Johns Hopkins Medical Institute Recruiting
Baltimore, Maryland, United States, 21287
Contact: Sara Boynton    443-287-9051   
Principal Investigator: Alicia Neu, MD         
Sub-Investigator: Michael Choi, MD         
Kidney Disease Section, NIDDK, NIH Recruiting
Bethesda, Maryland, United States, 20892
Contact: Evelyn Castro-Rubio    301-451-6994   
Principal Investigator: Jeffrey P. Kopp, MD         
United States, Michigan
CS Mott Children's Hospital, University of Michigan Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Emily Herreshoff    734-232-4851   
Sub-Investigator: Debbie Gipson, MD, MS         
University of Michigan Medical Center Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Chrysta C. Lienczewski, BS    734-615-5021   
Contact: , BS         
Principal Investigator: Matthias Kretzler, MD         
United States, Minnesota
Mayo Clinic Recruiting
Rochester, Minnesota, United States, 55905
Contact: Lori Riess    507-266-1047   
Contact: Daniel Veith    507-255-0231   
Principal Investigator: Fernando Fervenza, MD, PhD         
Sub-Investigator: John Lieske, MD         
Sub-Investigator: Marie C. Hogan, MD, PhD         
United States, Missouri
Children's Mercy Hospital Not yet recruiting
Kansas City, Missouri, United States, 64108
Contact: Amy Garrett, RN    816-234-3891   
Principal Investigator: Tarak Srivastava, MD         
United States, New York
Montefiore Medical Center Recruiting
Bronx, New York, United States, 11040
Contact: Patti Flynn, RN    718-655-1120   
Principal Investigator: Frederick Kaskel, MD         
Sub-Investigator: Robert Woroniecki, MD         
Cohen Children's Hospital Recruiting
New Hyde Park, New York, United States, 11040
Contact: Lulette Infante, RN    718-470-3499   
Contact: Daniel Jun   
Principal Investigator: Christine Sethna, MD         
New York University Medical Center Recruiting
New York, New York, United States, 10010
Contact: Frank Modersitzki, MPH    212-686-7500 ext 6379   
Contact: Suzanne Vento, RN   
Principal Investigator: Olga Zhadnova, MD         
Principal Investigator: Howard Trachtman, MD         
Bellevue Hospital Recruiting
New York, New York, United States, 10016
Contact: Frank Modersitzki, MPH    212-686-7500 ext 6379   
Principal Investigator: Laura Barisoni, MD         
Sub-Investigator: Olga Zhadnova, MD         
New York University Veterans Administration Recruiting
New York, New York, United States, 10016
Contact: Frank Modersitzki, MPH    212-686-7500 ext 6379   
Principal Investigator: Laura Barisoni, MD         
Sub-Investigator: Olga Zhadnova, MD         
Columbia University Medical Center Recruiting
New York, New York, United States, 10032
Contact: Michael Toledo, RN    212-305-6842   
Principal Investigator: Andrew Bomback, MD, MPH         
United States, North Carolina
University of North Carolina at Chapel Hill Recruiting
Chapel Hill, North Carolina, United States, 27599
Contact: Leslie Stewart    919-923-1382   
Contact: Sandra Grubbs, CPNP    919-966-2561 ext 245   
Principal Investigator: Patrick H. Nachman, MD         
Sub-Investigator: Susan L. Hogan, PhD, MPH         
Sub-Investigator: Keisha Gibson, MD         
Wake Forest School of Medicine Not yet recruiting
Winston-Salem, North Carolina, United States, 27157
Contact: Mitzie Spainhour    336-716-4246   
Contact: Stefanie Gray   
Principal Investigator: Jen-Jar Lin, MD         
United States, Ohio
University Hospital Rainbow Babies & Children's Hospital Recruiting
Cleveland, Ohio, United States, 44106
Contact: Marleen Schachere, RN    216-778-4321   
Sub-Investigator: Katherine Dell, MD         
MetroHealth Hospital at Case Western Medical Center Recruiting
Cleveland, Ohio, United States, 44109
Contact: Marleen Schachere, RN    216-778-4321   
Principal Investigator: John Sedor, MI         
Cleveland Clinic Foundation Recruiting
Cleveland, Ohio, United States, 44195
Contact: Annette Bellar, BS    216-636-5247   
Principal Investigator: Katherine M Dell, MD         
Cleveland Clinic Recruiting
Cleveland, Ohio, United States, 44195
Contact: Marleen Schachere, RN    216-778-4321   
Sub-Investigator: Surafel Gebreselassie, MD         
United States, Pennsylvania
Children's Hospital of Philadelphia Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Krishna Kallem, MS    484-358-0315   
Sub-Investigator: Kevin Meyers, MD         
University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Krishna Kallem, MS    484-358-0315   
Principal Investigator: Lawrence Holzman, MD         
Temple University Recruiting
Philadelphia, Pennsylvania, United States, 19140
Contact: Zoe Pfeffer, BS    215-707-4712   
Principal Investigator: Crystal Gadegbeku, MD         
Principal Investigator: Iris Lee, MD         
United States, Texas
University of Texas-Southwestern Recruiting
Dallas, Texas, United States, 75390
Contact: Natalie Johnson, LVN    214-645-8263   
Principal Investigator: Kamal Sambandam, MD         
United States, Washington
Seattle Children's Hospital Recruiting
Seattle, Washington, United States, 98145
Contact: JD (Jasdeep) Sandhu    206-884-1372   
Sub-Investigator: Sangeeta Hingorani, MD         
University of Washington Recruiting
Seattle, Washington, United States, 98195
Contact: Laura Curtin    203-221-3938   
Principal Investigator: Peter J. Nelson, MD         
Providence Medical Research Center Recruiting
Spokane, Washington, United States, 99204
Contact: Christopher Weber, CCRC    509-474-4327   
Contact: Ruth Franks, BSN, CCRC    509-474-4320   
Sub-Investigator: Katherine Tuttle, MD         
Canada, Ontario
Credit Valley Hospital Recruiting
Mississaugua, Ontario, Canada, L5M 2N1
Contact: Paul Ling, MD    416-340-3514   
Sub-Investigator: Phillip Boll, MD         
York Central Hospital Recruiting
Richmond Hill, Ontario, Canada, L4C 4Z3
Contact: Tami Baker    905-508-5911 ext 402   
Contact: Karen Chen    905-508-5911   
Sub-Investigator: Michael Pandes, MD         
Scarborough Hospital Recruiting
Scarborough, Ontario, Canada, M1H 3G4
Contact: Dione Rochester, BSc    416-279-0855 ext 230   
Sub-Investigator: Paul YW Tam, FRCP, FACP         
Sunnybrook Hospital Recruiting
Toronto, Ontario, Canada, M4N 3M5
Contact: Paul Ling, MD    416-340-3514   
Principal Investigator: Michelle Hladunewich, MD         
University Health Network Recruiting
Toronto, Ontario, Canada, M5G2C4
Contact: Paul Ling    416-340-3514   
Principal Investigator: Daniel Cattran, MD         
Sub-Investigator: Heather Reich, MD         
Sub-Investigator: Michelle Hladunewich, MD         
Sponsors and Collaborators
University of Michigan
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The NephCure Foundation
Principal Investigator: Matthias Kretzler, MD University of Michigan
  More Information

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Matthias Kretzler, Professor, University of Michigan Identifier: NCT01209000     History of Changes
Obsolete Identifiers: NCT01240564
Other Study ID Numbers: 6801
1U54DK083912 ( US NIH Grant/Contract Award Number )
Study First Received: July 29, 2010
Last Updated: October 10, 2016

Keywords provided by University of Michigan:
Focal and Segmental Glomerulosclerosis
Focal & Segmental Glomerulosclerosis
Focal Segmental Glomerulosclerosis
Minimal change disease
Membranous Nephropathy
Nephrotic Syndrome
Neph Syndrome

Additional relevant MeSH terms:
Kidney Diseases
Nephrotic Syndrome
Glomerulonephritis, Membranous
Nephrosis, Lipoid
Glomerulosclerosis, Focal Segmental
Pathologic Processes
Urologic Diseases
Autoimmune Diseases
Immune System Diseases processed this record on April 21, 2017