Vesicoureteral RefluxNCT01137929
Bacterial and Host Genetic Risk Factors in Acute Pyelonephritis
An observational study of Vesicoureteral Reflux, run by Hans Pohl.
Trial summary
No single host or pathogen trait identified by previous research can be correlated with all cases of childhood acute pyelonephritis or APN (i.e., kidney/upper urinary tract infections) and APN-associated renal scarring (the outcome with the highest morbidity), making it difficult for physicians to determine which… Read more about this study
- Who is it for?
- Ages 2 to 24 months
- Conditions the study is for
- Vesicoureteral Reflux
- How many people
- 0 participants
- Where
- No sites listed yet
- Study dates
- Nov 2014to Nov 2016
- Phase
- Observational
- Are there results?
- None posted in the registry
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 2 to 24 months
- All sexes
- No healthy volunteers
- Child
Study population: We will identify infants ≤ 2 years to be of particular risk for UTIF and renal scarring by virtue of a variety of risk factors, including age, gender, race, and underlying genetic risk factors and bacterial phenotypes.
Who may be able to join
- Infants admitted to the inpatient ward at Children's National Medical Center for the treatment of a febrile urinary tract infection (see definitions) will be screened for inclusion into the research protocol.
- UTIF: A UTIF will require the presence of
- (1) fever and/or symptoms consistent with UTI,
- (2) pyuria based on urinalysis, and
- (3) culture-proven infection with a single organism. Specifically, the study definition of UTIF will require:
- Fever: A documented temperature of at least 100.4 °F or 38°C, measured anywhere on the body either at home or at doctor's office.
- Positive dipstick analysis: Pyuria on urinalysis (>10 WBC/mm3 (uncentrifuged specimen) OR >5 WBC/hpf (centrifuged specimen), OR >1+ leukocyte esterase on dipstick).
- Culture documentation of UTI: Evidence of bacteria (>5 x 104 CFU/mL (catheterized or suprapubic aspiration urine specimen). Bag collected specimens will not be acceptable
Who cannot join
- Infants who do not conform to the above inclusion criteria and who have co-morbidities such as duplication abnormalities, diabetes mellitus, over weight status, anatomical defects of the urinary tract and neuropathic bladder dysfunction.
About this study
Official title: Bacterial and Host Genetic Risk Factors That Predispose Children to Acute Pyelonephritis and Renal Scarring
No single host or pathogen trait identified by previous research can be correlated with all cases of childhood acute pyelonephritis or APN (i.e., kidney/upper urinary tract infections) and APN-associated renal scarring (the outcome with the highest morbidity), making it difficult for physicians to determine which patients will be affected. Our proposal is to comprehensively study the relationships between the clinical manifestations of urinary tract infections (UTIs), the host risk factors and immune response, and the microbial species that cause these conditions. The result of the study will be a clinical severity score to personalize diagnostic and treatment strategies for infants with UTI, with the goal of decreasing the morbidity of APN/renal scarring and improving patient outcomes.
Read the detailed description
Urinary tract infections (UTIs) are the most common serious bacterial infections in young children, with acute pyelonephritis or APN (i.e., kidney/upper urinary tract infections) and APN-associated renal scarring causing the most potential long-term damage to a child's health. Approximately two-thirds of young children with febrile UTI (UTIF or UTI presenting with fever) will have APN, making UTIF a major indicator of APN. Other than the presence of fever, it is currently difficult for physicians to determine which infant patients have or will develop APN and renal scarring. Individual risk factors for the host (e.g., uncircumcised males, cytokine production) and the pathogen (e.g., presence of fimbriae for adhesion) have individually been linked to APN and renal scarring, but no single trait identified can be correlated with all cases. Multiple factors on both sides of the host-pathogen relationship likely interact to determine the severity of the illness and the outcome. Although the NIDDK/NIH is currently funding two clinical trials to investigate the rate of recurrent UTI and the rate of renal scarring in children (Randomized Intervention of Children with Vesicoureteral REflux, RIVUR; and Careful urinary Tract Infection Evaluation, CUTIE) neither of these studies will be able to identify the child's initial risk for having APN since patient recruitment will occur too long after treatment of the UTI. Also, neither study proposes as a specific goal to obtain bacteriological samples with which to study the microbe's role in the pathogenesis of APN. Thus, to the best of our knowledge, no comprehensive study exists that aims to analyze the relationships between the clinical manifestations of UTIs, the host risk factors and immune response, and the microbial species that cause these conditions. Our proposed collaborative study between Children's National Medical Center (CNMC) and the J. Craig Venter Institute (JCVI) will collect clinical data as well as urine and blood samples from six distinct infant patient populations presenting with UTIF and correlate the clinical, host, and pathogen data for each patient with the severity of the disease and development of APN and renal scarring. Metagenomic and genomic sequencing on the urine and isolated bacteria, respectively, will allow us to comprehensively study both the culturable and unculturable pathogens responsible for the UTI. Using a genome-wide association study (GWAS) we will evaluate the polymorphisms of all known UTI-associated host genes, paying particular attention to the immune system host genes previously identified as potentially linked to APN. To correlate all collected data a publicly available database and website will be created to allow physicians and scientists to traverse the data. Using the data collected in the database, the final result of the study will be a clinical severity score to personalize diagnostic and treatment strategies for infants with UTIF, with the goal of decreasing the morbidity of APN and improving patient outcomes. An improved understanding of the microbial risk factors associated with APN and renal scarring will allow for better diagnostic approaches and improved methods for treating patients, inclusive of novel medications in at risk individuals.
- Conditions
- Vesicoureteral Reflux
- Keywords
- Vesicoureteral reflux, Kidney, Renal Scar, Urinary tract infection
- Medical subject headings
- Vesico-Ureteral Reflux, Urinary Tract Infections
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| With APN, With VUR, With Renal Scar | This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan and will also have VUR by VCUG and a renal scar on follow-up DMSA renal scan. | |
| With APN, With VUR, Without Renal Scar | This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan and will also have VUR by VCUG and NO renal scar on follow-up DMSA renal scan. | |
| With APN, without VUR, with Renal Scar | This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan but who will NOT have VUR by VCUG; however they will have a renal scar on follow-up DMSA renal scan. | |
| With APN, Without VUR, Without Renal Scar | This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan and will NOT have VUR by VCUG, NOR will they have a renal scar on follow-up DMSA renal scan. | |
| Without APN, With VUR | This group of children who present with a febrile UTI will be found NOT to have APN on DMSA renal scan and will also have VUR by VCUG. They will not undergo a second DMSA scan since the first one is normal. | |
| Without APN, Without VUR | This group of children who present with a febrile UTI will be found NOT to have APN on DMSA renal scan and will also NOT have VUR by VCUG, NOR a renal scar on follow-up DMSA renal scan. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of acute pyelonephritis lesions
Children under two years of age will undergo a 99m-Tc-DMSA renal scan for the detection of acute pyelonephritis lesions within 72 hours of presentation to the ED for evaluation of a fever and positive urine culture. Based on finding the characteristic lesions (such as preservation of the renal contour but with diminished photopenia.
This outcome measure will be aggregated with other bacterial and host related risk factors in order to identify the salient ones that result in morbidity from bladder infection.
Measured: < 72 hours after presentation with fever and positive urine culture
Secondary outcomes (1)
Incidence of renal cortical scarring
Since the lesions associated with acute pyelonephritis can resolve up to 6 months following infection, we will stress the importance of obtaining these delayed scans for the purpose of ascertaining whether the inflammation has resulted in a fixed lesion, termed a renal scar.
Measured: At least 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Jun 2010 (estimated)
- Study startNov 2014
- Primary completionNov 2016 (estimated)
- Study completionNov 2016 (estimated)
Why it stopped: Difficulty identifying eligible candidates
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Vesicoureteral RefluxStudies of the same condition, open and under way.
- 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
- Case-control
- Time perspective
- Prospective
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- Hans Pohl
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Hans Pohl, Children's National Research Institute
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01137929
- Sponsor's protocol ID
- Genes-APN
- Status last verified
- Oct 2014
- First submitted
- 3 Jun 2010
- Last updated
- 2 Oct 2014
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 2 Oct 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Bacterial and Host Genetic Risk Factors That Predispose Children to Acute Pyelonephritis and Renal Scarring
- ClinicalTrials.gov ID
- NCT01137929
- Acronym / sponsor ID
- Genes-APN
- Conditions
- Vesicoureteral Reflux
- Keywords
- Vesicoureteral reflux, Kidney, Renal Scar, Urinary tract infection
- Study type
- Observational
- Recruitment status
- WithdrawnReason stopped: Difficulty identifying eligible candidates
- Enrolment
- 0 participants (actual)
- Lead sponsor
- Hans PohlUniversity, hospital or other
- Study start
- Nov 2014
- Primary completion
- Nov 2016 (estimated)
- Study completion
- Nov 2016 (estimated)
- First posted
- 7 Jun 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.
No single host or pathogen trait identified by previous research can be correlated with all cases of childhood acute pyelonephritis or APN (i.e., kidney/upper urinary tract infections) and APN-associated renal scarring (the outcome with the highest morbidity), making it difficult for physicians to determine which patients will be affected. Our proposal is to comprehensively study the relationships between the clinical manifestations of urinary tract infections (UTIs), the host risk factors and immune response, and the microbial species that cause these conditions. The result of the study will be a clinical severity score to personalize diagnostic and treatment strategies for infants with UTI, with the goal of decreasing the morbidity of APN/renal scarring and improving patient outcomes.
Detailed description
Urinary tract infections (UTIs) are the most common serious bacterial infections in young children, with acute pyelonephritis or APN (i.e., kidney/upper urinary tract infections) and APN-associated renal scarring causing the most potential long-term damage to a child's health. Approximately two-thirds of young children with febrile UTI (UTIF or UTI presenting with fever) will have APN, making UTIF a major indicator of APN. Other than the presence of fever, it is currently difficult for physicians to determine which infant patients have or will develop APN and renal scarring. Individual risk factors for the host (e.g., uncircumcised males, cytokine production) and the pathogen (e.g., presence of fimbriae for adhesion) have individually been linked to APN and renal scarring, but no single trait identified can be correlated with all cases. Multiple factors on both sides of the host-pathogen relationship likely interact to determine the severity of the illness and the outcome. Although the NIDDK/NIH is currently funding two clinical trials to investigate the rate of recurrent UTI and the rate of renal scarring in children (Randomized Intervention of Children with Vesicoureteral REflux, RIVUR; and Careful urinary Tract Infection Evaluation, CUTIE) neither of these studies will be able to identify the child's initial risk for having APN since patient recruitment will occur too long after treatment of the UTI. Also, neither study proposes as a specific goal to obtain bacteriological samples with which to study the microbe's role in the pathogenesis of APN. Thus, to the best of our knowledge, no comprehensive study exists that aims to analyze the relationships between the clinical manifestations of UTIs, the host risk factors and immune response, and the microbial species that cause these conditions. Our proposed collaborative study between Children's National Medical Center (CNMC) and the J. Craig Venter Institute (JCVI) will collect clinical data as well as urine and blood samples from six distinct infant patient populations presenting with UTIF and correlate the clinical, host, and pathogen data for each patient with the severity of the disease and development of APN and renal scarring. Metagenomic and genomic sequencing on the urine and isolated bacteria, respectively, will allow us to comprehensively study both the culturable and unculturable pathogens responsible for the UTI. Using a genome-wide association study (GWAS) we will evaluate the polymorphisms of all known UTI-associated host genes, paying particular attention to the immune system host genes previously identified as potentially linked to APN. To correlate all collected data a publicly available database and website will be created to allow physicians and scientists to traverse the data. Using the data collected in the database, the final result of the study will be a clinical severity score to personalize diagnostic and treatment strategies for infants with UTIF, with the goal of decreasing the morbidity of APN and improving patient outcomes. An improved understanding of the microbial risk factors associated with APN and renal scarring will allow for better diagnostic approaches and improved methods for treating patients, inclusive of novel medications in at risk individuals.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 6
| Arm | Type | Receives |
|---|---|---|
| With APN, With VUR, With Renal Scar | – | –This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan and will also have VUR by VCUG and a renal scar on follow-up DMSA renal scan. |
| With APN, With VUR, Without Renal Scar | – | –This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan and will also have VUR by VCUG and NO renal scar on follow-up DMSA renal scan. |
| With APN, without VUR, with Renal Scar | – | –This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan but who will NOT have VUR by VCUG; however they will have a renal scar on follow-up DMSA renal scan. |
| With APN, Without VUR, Without Renal Scar | – | –This group of children who present with a febrile UTI will be found to have APN on DMSA renal scan and will NOT have VUR by VCUG, NOR will they have a renal scar on follow-up DMSA renal scan. |
| Without APN, With VUR | – | –This group of children who present with a febrile UTI will be found NOT to have APN on DMSA renal scan and will also have VUR by VCUG. They will not undergo a second DMSA scan since the first one is normal. |
| Without APN, Without VUR | – | –This group of children who present with a febrile UTI will be found NOT to have APN on DMSA renal scan and will also NOT have VUR by VCUG, NOR a renal scar on follow-up DMSA renal scan. |
Who may qualify
- Ages
- 2 to 24 months
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
- Study population
- We will identify infants ≤ 2 years to be of particular risk for UTIF and renal scarring by virtue of a variety of risk factors, including age, gender, race, and underlying genetic risk factors and bacterial phenotypes.
Key inclusion criteria (8 listed)
- Infants admitted to the inpatient ward at Children's National Medical Center for the treatment of a febrile urinary tract infection (see definitions) will be screened for inclusion into the research protocol.
- UTIF: A UTIF will require the presence of
- Fever: A documented temperature of at least 100.4 °F or 38°C, measured anywhere on the body either at home or at doctor's office.
- Positive dipstick analysis: Pyuria on urinalysis (>10 WBC/mm3 (uncentrifuged specimen) OR >5 WBC/hpf (centrifuged specimen), OR >1+ leukocyte esterase on dipstick).
- Culture documentation of UTI: Evidence of bacteria (>5 x 104 CFU/mL (catheterized or suprapubic aspiration urine specimen). Bag collected specimens will not be acceptable
Key exclusion criteria (1 listed)
- Infants who do not conform to the above inclusion criteria and who have co-morbidities such as duplication abnormalities, diabetes mellitus, over weight status, anatomical defects of the urinary tract and neuropathic bladder dysfunction.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Incidence of acute pyelonephritis lesions
Time frame: < 72 hours after presentation with fever and positive urine culture
Children under two years of age will undergo a 99m-Tc-DMSA renal scan for the detection of acute pyelonephritis lesions within 72 hours of presentation to the ED for evaluation of a fever and positive urine culture. Based on finding the characteristic lesions (such as preservation of the renal contour but with diminished photopenia. This outcome measure will be aggregated with other bacterial and host related risk factors in order to identify the salient ones that result in morbidity from bladder infection.
1 secondary outcome
Incidence of renal cortical scarring
Time frame: At least 6 months
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Oct 2014.
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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. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
An observational study of Vesicoureteral Reflux, run by Hans Pohl.
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 8 inclusion and 1 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: withdrawn, as of the sponsor's last update on 2 Oct 2014. Status can change between updates, so confirm with the study contact before making plans.
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?
The study was withdrawn before enrolling participants, so there are no results.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Incidence of acute pyelonephritis lesions (time frame: < 72 hours after presentation with fever and positive urine culture). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 2 Oct 2014.