Minimal Change Disease (MCD)NEPTUNENCT01209000
Nephrotic Syndrome Study Network
An observational study of Minimal Change Disease (MCD) and Membranous Nephropathy, run by University of Michigan at 44 sites in 2 countries.
Trial summary
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. Read more about this study
- Who is it for?
- Ages Up to 80 years
- Conditions the study is for
- Minimal Change Disease (MCD), Membranous Nephropathy, Glomerulosclerosis, Focal Segmental
- What is being tested?
- Kidney Biopsy
- Type of treatment
- Surgery or procedure
- How many people
- 1,200 participants
- Where
- 44 sitesin 2 countries
- Study dates
- Apr 2010to 31 Dec 2030
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Up to 80 years
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
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 participating clinical centers will be eligible for Cohort A (biopsy cohort) study population targeted for enrollment into the NEPTUNE study. 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, presenting for nephrotic syndrome and less than 30 days of immunosuppression therapy exposure, will also be targeted for enrollment into the cNEPTUNE study. Potential participants willing to receive their initial care and subsequent follow-up study visits at one of these sites are welcome to participate.
Who may be able to join
None listed.
Who cannot join
- 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)
Trial locations and contacts
44 sites in 2 countries. Contact the study team or a site near you to ask about taking part.
44 sites in 2 countries
United States39 sites, 34 recruiting
- Recruiting
CS Mott Children's Hospital, University of Michigan
Ann Arbor, Michigan, 48109
Hailey Desmond, MS, 734-232-4851, heturner@umich.edu
Debbie Gipson, MD, MS
- Recruiting
University of Michigan Medical Center
Ann Arbor, Michigan, 48109
Chrysta C. Lienczewski, BS - adult, 734-615-5021, boridley@med.umich.edu
Amanda Williams, BS - adult, 734-615-5017, amwi@umich.edu
- Recruiting
Emory University and Children's Healthcare of Atlanta
Atlanta, Georgia, 30322
Emily Yun, 404-712-9998, emily.yun@emory.edu
Laurence Greenbaum, MD, PhD
- Not yet recruiting
Children's Hospital Colorado
Aurora, Colorado, 80045
Nathan Rogers, Nathan.Rogers@childrenscolorado.org
Gabriel Cara-Fuentes, MD
- Not yet recruiting
University of Colorado Anschutz School of Medicine
Aurora, Colorado, 80045
Elizabeth Wagner, elizabeth.c.wagner@cuanschutz.edu
Amber Podoll, MD
- Recruiting
Johns Hopkins Medical Institute
Baltimore, Maryland, 21287
Sara Boynton, 443-287-9051, sboynto3@jhmi.edu
Alicia Neu, MD
- Completed
Kidney Disease Section, NIDDK, NIH
Bethesda, Maryland, 20892
- Recruiting
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, 27599
Anne Froment, 919-923-1382, Anne_Froment@med.unc.edu
Fernanda Ochoa, ferochoa@email.unc.edu
- Recruiting
Medical University of South Carolina
Charleston, South Carolina, 29425
David Selewski, MD, MS
- Recruiting
Atrium Health Levine Children's Hospital
Charlotte, North Carolina, 28203
Layla Lo, nkauj.lo@atriumhealth.org
Susan Massengill, MD
- Recruiting
John Stroger Cook County Hospital
Chicago, Illinois, 60680
Mathew Itteera, 312-864-4614, mitteera@cookcountyhhs.org
Ambarish Athavale, MD
- Completed
University Hospital Rainbow Babies & Children's Hospital
Cleveland, Ohio, 44106
- Completed
MetroHealth Hospital at Case Western Medical Center
Cleveland, Ohio, 44109
- Recruiting
Cleveland Clinic
Cleveland, Ohio, 44195
Stefanie Larson, larsons2@ccf.org
Villarreal
- Recruiting
The Ohio State University Wexner Medical Center
Columbus, Ohio, 43210
Alexander Price, alexander.price2@osumc.edu
Salem Almaani, MD
- Recruiting
University of Texas-Southwestern
Dallas, Texas, 75390
Elizabeth Robles, elizabeth.robles@utsouthwestern.edu
Kamal Sambandam, MD
- Recruiting
Texas Children's Hospital - Baylor College of Medicine
Houston, Texas, 77030
Aisha Deslandes, aisha.deslandes@bcm.edu
Shweta S. Shah, MD
- Recruiting
University of Kansas Medical Center
Kansas City, Kansas, 66160
Catherine Creed, ccreed@kumc.edu
Ellen McCarthy, MD
- Recruiting
Children's Mercy Hospital
Kansas City, Missouri, 64108
Kelsey Markus, kemarkus@cmh.edu
Tarak Srivastava, MD
- Recruiting
University of Southern California-Children's Hospital
Los Angeles, California, 90227
Sharon Tang, BSN, 323-361-7299, shatang@chla.usc.edu
Kevin Lemley, MD, PhD
- Recruiting
University of Miami Miller School of Medicine
Miami, Florida, 33136
Carlos Bidot, 305-243-8973, cbidot2@miami.edu
Alessia Fornoni, MD. PhD
- Recruiting
Cohen Children's Hospital
New Hyde Park, New York, 11040
Suzanne Vento, BSN, 718-470-3499, svento@northwell.edu
Christine Sethna, MD
- Recruiting
New York University Medical Center
New York, New York, 10010
Frank Modersitzki, MPH - adult, 212-686-7500 ext. 6379, Frank.Modersitzki@va.gov
Laura Jane Pehrson - peds, laurajane.pehrson@nyulangone.org
- Recruiting
Bellevue Hospital
New York, New York, 10016
Frank Modersitzki, MPH, 212-686-7500 ext. 6379, Frank.Modersitzki@va.gov
Laura Barisoni, MD
- Recruiting
New York University Veterans Administration
New York, New York, 10016
Frank Modersitzki, MPH, 212-686-7500 ext. 6379, Frank.Modersitzki@va.gov
Laura Barisoni, MD
- Recruiting
Columbia University Medical Center
New York, New York, 10032
Anup Pradhan, 212-305-6842, arp2209@cumc.columbia.edu
Andrew Bomback, MD, MPH
- Recruiting
Stanford University School of Medicine
Palo Alto, California, 94304
Kshama Mehta, PhD, 650-736-1822, krmehta@stanford.edu
Richard Lafayette, MD
- Recruiting
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
Alilya Edwards, EdwardsA1@chop.edu
Kevin Meyers, MD
- Recruiting
University of Pennsylvania
Philadelphia, Pennsylvania, 19104
Krishna Kallem, MD - adult, MS, 484-358-0315, krishna.kallem@uphs.upenn.edu
Aliya Edwards - peds, EdwardsA1@chop.edu
- Recruiting
Temple University
Philadelphia, Pennsylvania, 19140
Zoe Pfeffer, BS, 215-707-4712, zoe.pfeffer@tuhs.temple.edu
Crystal Gadegbeku, MD
- Completed
Mayo Clinic
Rochester, Minnesota, 55905
- Not yet recruiting
University of California San Francisco Benioff Children's Hospitals
San Francisco, California, 94158
Daniel Schrader, daniel.schrader@ucsf.edu
Paul Brakeman, MD, PhD
- Recruiting
Seattle Children's Hospital
Seattle, Washington, 98145
Emily Pao, emily.pao@seattlechildrens.org
Sangeeta Hingorani, MD
- Recruiting
University of Washington
Seattle, Washington, 98195
Linda Manahan, BSN, lmanahan@nephrology.washington.edu
Peter J. Nelson, MD
- Recruiting
Providence Medical Research Center
Spokane, Washington, 99204
Ann Cooper, CCRC, 509-474-4327, Ann.Cooper@providence.org
Kelli Kuykendall, CCRC, 509-474-4320, Kelli.Kuykendall@providence.org
- Not yet recruiting
Washington University - St Louis
St Louis, Missouri, 63110
Leslie Walther, leslie.walther@wustl.edu
Vikas Dharnidharka, MD, PhD
- Recruiting
Montefiore Medical Center
The Bronx, New York, 11040
Patti Flynn, RN, 718-655-1120, pflynn@montefiore.org
Frederick Kaskel, MD
- Recruiting
Lundquist Biomedical Research Institute at Harbor UCLA Medical Center
Torrance, California, 90502
Janine LaPage, 310-222-4104, jlapage@labiomed.org
Sharon Adler, MD
- Withdrawn
Wake Forest School of Medicine
Winston-Salem, North Carolina, 27157
Canada5 sites, 3 recruiting
- Completed
York Central Hospital
Richmond Hill, Ontario, L4C 4Z3
- Completed
Scarborough Hospital
Scarborough Village, Ontario, M1H 3G4
- Recruiting
Credit Valley Hospital
Toronto, Ontario, L5M 2N1
Martin Romano, MD, 416-340-3514, martin.romano@thp.ca
Phillip Boll, MD
- Recruiting
Sunnybrook Hospital
Toronto, Ontario, M4N 3M5
Rhea O'Neill, rhea.oneill@sri.utoronto.ca
Michelle Hladunewich, MD
- Recruiting
University Health Network
Toronto, Ontario, M5G2C4
Paul Ling, MD, 416-340-3514, pling@uhnresearch.ca
Martin Romano, MD, Martin.Romano@trilliumhealthpartners.ca
About this study
Official title: Nephrotic Syndrome Study Network Under the Rare Diseases Clinical Research Network
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.
Read the 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.
- Being tested
- Kidney Biopsy
- Keywords
- Focal and Segmental Glomerulosclerosis, Focal & Segmental Glomerulosclerosis, Focal Segmental Glomerulosclerosis, FSGS, Minimal change disease, MCD, Membranous Nephropathy, MN, Nephrotic Syndrome, Neph Syndrome, NEPTUNE, NephCure, Halpin
- Medical subject headings
- Nephrosis, Lipoid, Glomerulonephritis, Membranous, Glomerulosclerosis, Focal Segmental, Macular dystrophy, corneal type 1, Nephrotic Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Kidney BiopsyProcedure or surgery
Patients scheduled to undergo a clinically indicated kidney biopsy will be requested to consent to an additional renal core, to be set aside until all clinical care is complete.
| Study group | Role | What they receive |
|---|---|---|
| FSGS/MCD Cohort (Cohort A) | Focal Segmental Glomerulosclerosis/Minimal Change Disease (FSGS/MCD) Cohort
Participants enrolled in NEPTUNE with a biopsy proven histological diagnosis for FSGS or MCD.
Eligible participants must be scheduled for a clinically indicated renal biopsy. Receives: Procedure: Kidney Biopsy | |
| MN Cohort (Cohort A) | Membranous Nephropathy (MN) Cohort
Participants enrolled in NEPTUNE with a biopsy proven histological diagnosis for MN.
Eligible participants must be scheduled for a clinically indicated renal biopsy. Receives: Procedure: Kidney Biopsy | |
| Other glomerulopathies cohort | Participants enrolled in NEPTUNE and determined to not have FSGS/MCD or MN will be followed in a third group.
Eligible participants must be scheduled for a clinically indicated renal biopsy. Receives: Procedure: Kidney Biopsy | |
| cNEPTUNE (Cohort B) | Participants < 19 years of age, with < 30 days exposure to immunosuppression therapy who are not scheduled for renal biopsy. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Event rate of change in urinary protein excretion and renal function.
Defined as remission, partial remission and non-remission
Measured: 60 months
Rate of change in renal function.
Defined as:
- 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
- 50% decline in follow-up estimated GFR compared to baseline measurement
- End stage renal disease defined as estimated GFR ≤10cc/min, initiation of maintenance dialysis or preemptive kidney transplantation.
Measured: 60 months
Secondary outcomes (9)
Quality of Life:
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).
Measured: 60 months
Malignancies
Any cancer diagnosis of the skin, hematopoietic system, or solid organ after enrollment in NEPTUNE
Measured: 60 months
Infections, Serious and Systemic
Infections including one of the following:
- 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.
- Hospitalization for treatment of infection
Measured: 60 months
Thromboembolic Events
Documented diagnosis of one of the following:
- Embolic cerebrovascular accident
- Deep venous thrombosis
- Renal vein thrombosis or
- Pulmonary embolus
Measured: 60 months
Hospitalization
Documented hospital admission, including observation for ≥24 hours.
Measured: 60 months
Emergency Department/ Observation Unit Visit
Documented visit to an emergency department or observation unit that does not lead to hospitalization and is less than 24 hours.
Measured: 60 months
Acute Kidney Injury
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.
Measured: 60 months
Death
- Documentation of death that is secondary to infection or sepsis.
- 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
- Documentation of death secondary to cancer
- Other Death: Documentation of death that does not fall into the above categories.
Measured: 60 months
New Onset Diabetes
Diagnosis of diabetes as indicated by 1 or more of the following not present at NEPTUNE Enrollment:
- Documented diagnosis of diabetes in medical record
- 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%
Measured: 60 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Sep 2010 (estimated)
- Study startApr 2010
- Primary completion31 Dec 2030 (estimated)
- Study completion31 Dec 2030 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Minimal Change Disease (MCD)Studies of the same condition, open and under way.
- More trials run by University of MichiganThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 1,200 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Michigan
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), The NephCure Foundation
- Responsible party
- Principal investigator, Matthias Kretzler, University of Michigan
- Investigators
- Matthias Kretzler, MD, Principal investigator, University of Michigan
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01209000
- Sponsor's protocol ID
- 6801
- Other IDs
- 1U54DK083912, 1R01DK141114-01A1
- Acronym
- NEPTUNE
- Status last verified
- Jun 2026
- First submitted
- 29 Jul 2010
- Last updated
- 10 Jun 2026
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Wang CS, Troost JP, Wang Y, Greenbaum LA, Gibson K, Trachtman H, Srivastava T, Reidy K, Kaskel F, Sethna CB, Meyers K, Dell KM, Tran CL, Hingorani S, Lemley KV, Lin JJ, Gipson DS. Determinants of medication adherence in childhood nephrotic syndrome and associations of adherence with clinical outcomes. Pediatr Nephrol. 2022 Jul;37(7):1585-1595. doi: 10.1007/s00467-021-05176-8. Epub 2021 Nov 18.
PubMed 34796395Solagna F, Tezze C, Lindenmeyer MT, Lu S, Wu G, Liu S, Zhao Y, Mitchell R, Meyer C, Omairi S, Kilic T, Paolini A, Ritvos O, Pasternack A, Matsakas A, Kylies D, Wiesch JSZ, Turner JE, Wanner N, Nair V, Eichinger F, Menon R, Martin IV, Klinkhammer BM, Hoxha E, Cohen CD, Tharaux PL, Boor P, Ostendorf T, Kretzler M, Sandri M, Kretz O, Puelles VG, Patel K, Huber TB. Pro-cachectic factors link experimental and human chronic kidney disease to skeletal muscle wasting programs. J Clin Invest. 2021 Jun 1;131(11):e135821. doi: 10.1172/JCI135821.
PubMed 34060483Kang H, Kim DR, Jung YH, Baek CW, Park YH, In Oh J, Kim WJ, Choi GJ. Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study. BMC Anesthesiol. 2015 Nov 20;15:167. doi: 10.1186/s12871-015-0151-4.
PubMed 26589142Hogan MC, Lieske JC, Lienczewski CC, Nesbitt LL, Wickman LT, Heyer CM, Harris PC, Ward CJ, Sundsbak JL, Manganelli L, Ju W, Kopp JB, Nelson PJ, Adler SG, Reich HN, Holzmann LB, Kretzler M, Bitzer M. Strategy and rationale for urine collection protocols employed in the NEPTUNE study. BMC Nephrol. 2015 Nov 17;16:190. doi: 10.1186/s12882-015-0185-3.
PubMed 26577187
Study at a glance
From the registry record, last updated by the sponsor on 10 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Nephrotic Syndrome Study Network Under the Rare Diseases Clinical Research Network
- ClinicalTrials.gov ID
- NCT01209000
- Acronym / sponsor ID
- NEPTUNE / 6801
- Keywords
- Focal and Segmental Glomerulosclerosis, Focal & Segmental Glomerulosclerosis, Focal Segmental Glomerulosclerosis, FSGS, Minimal change disease, MCD, Membranous Nephropathy, MN
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 1,200 participants (estimated)
- Lead sponsor
- University of MichiganUniversity, hospital or other
- Collaborators
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), The NephCure Foundation
- Study start
- Apr 2010 (actual)
- Primary completion
- 31 Dec 2030 (estimated)
- Study completion
- 31 Dec 2030 (estimated)
- First posted
- 24 Sep 2010 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
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.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| FSGS/MCD Cohort (Cohort A) | – | Procedure: Kidney BiopsyFocal Segmental Glomerulosclerosis/Minimal Change Disease (FSGS/MCD) Cohort Participants enrolled in NEPTUNE with a biopsy proven histological diagnosis for FSGS or MCD. Eligible participants must be scheduled for a clinically indicated renal biopsy. |
| MN Cohort (Cohort A) | – | Procedure: Kidney BiopsyMembranous Nephropathy (MN) Cohort Participants enrolled in NEPTUNE with a biopsy proven histological diagnosis for MN. Eligible participants must be scheduled for a clinically indicated renal biopsy. |
| Other glomerulopathies cohort | – | Procedure: Kidney BiopsyParticipants enrolled in NEPTUNE and determined to not have FSGS/MCD or MN will be followed in a third group. Eligible participants must be scheduled for a clinically indicated renal biopsy. |
| cNEPTUNE (Cohort B) | – | –Participants < 19 years of age, with < 30 days exposure to immunosuppression therapy who are not scheduled for renal biopsy. |
Who may qualify
- Ages
- Up to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- 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 participating clinical centers will be eligible for Cohort A (biopsy cohort) study population targeted for enrollment into the NEPTUNE study. 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, presenting for nephrotic syndrome and less than 30 days of immunosuppression therapy exposure, will also be targeted for enrollment into the cNEPTUNE study. Potential participants willing to receive their initial care and subsequent follow-up study visits at one of these sites are welcome to participate.
Key inclusion criteria (0 listed)
Key exclusion criteria (8 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Kidney BiopsyPatients scheduled to undergo a clinically indicated kidney biopsy will be requested to consent to an additional renal core, to be set aside until all clinical care is complete. | Procedure or surgery | FSGS/MCD Cohort (Cohort A), MN Cohort (Cohort A), Other glomerulopathies cohort |
Primary outcome
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.
9 secondary outcomes
Quality of Life:
Time frame: 60 months
Malignancies
Time frame: 60 months
Infections, Serious and Systemic
Time frame: 60 months
Thromboembolic Events
Time frame: 60 months
Hospitalization
Time frame: 60 months
Emergency Department/ Observation Unit Visit
Time frame: 60 months
Acute Kidney Injury
Time frame: 60 months
Death
Time frame: 60 months
New Onset Diabetes
Time frame: 60 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Jun 2026.
- Derived from this study: PubMed 34796395Wang CS, Troost JP, Wang Y, Greenbaum LA, Gibson K, Trachtman H, Srivastava T, Reidy K, Kaskel F, Sethna CB, Meyers K, Dell KM, Tran CL, Hingorani S, Lemley KV, Lin JJ, Gipson DS. Determinants of medication adherence in childhood nephrotic syndrome and associations of adherence with clinical outcomes. Pediatr Nephrol. 2022 Jul;37(7):1585-1595. doi: 10.1007/s00467-021-05176-8. Epub 2021 Nov 18.
- Derived from this study: PubMed 34060483Solagna F, Tezze C, Lindenmeyer MT, Lu S, Wu G, Liu S, Zhao Y, Mitchell R, Meyer C, Omairi S, Kilic T, Paolini A, Ritvos O, Pasternack A, Matsakas A, Kylies D, Wiesch JSZ, Turner JE, Wanner N, Nair V, Eichinger F, Menon R, Martin IV, Klinkhammer BM, Hoxha E, Cohen CD, Tharaux PL, Boor P, Ostendorf T, Kretzler M, Sandri M, Kretz O, Puelles VG, Patel K, Huber TB. Pro-cachectic factors link experimental and human chronic kidney disease to skeletal muscle wasting programs. J Clin Invest. 2021 Jun 1;131(11):e135821. doi: 10.1172/JCI135821.
- Derived from this study: PubMed 26589142Kang H, Kim DR, Jung YH, Baek CW, Park YH, In Oh J, Kim WJ, Choi GJ. Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study. BMC Anesthesiol. 2015 Nov 20;15:167. doi: 10.1186/s12871-015-0151-4.
- Derived from this study: PubMed 26577187Hogan MC, Lieske JC, Lienczewski CC, Nesbitt LL, Wickman LT, Heyer CM, Harris PC, Ward CJ, Sundsbak JL, Manganelli L, Ju W, Kopp JB, Nelson PJ, Adler SG, Reich HN, Holzmann LB, Kretzler M, Bitzer M. Strategy and rationale for urine collection protocols employed in the NEPTUNE study. BMC Nephrol. 2015 Nov 17;16:190. doi: 10.1186/s12882-015-0185-3.
- Rare Diseases Clinical Research Networks HomepageLink provided by the sponsor.
- Patient Advocacy group for FSGS/MCDLink provided by the sponsor.
- Patient advocacy group for MNLink provided by the sponsor.
- The NEPTUNE Study HomepageLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Matthias Kretzler, MD principal investigator
University of Michigan
44 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Minimal Change Disease (MCD) and Membranous Nephropathy, run by University of Michigan at 44 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 0 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 10 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 44 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Chrysta C. Lienczewski, BS (734-615-5021, NEPTUNE-Study@umich.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Event rate of change in urinary protein excretion and renal function. (time frame: 60 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01209000, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jun 2026.