Citations 2
Fibrillary Glomerulonephritis: Clinicopathologic Features and Outcomes
Sawaf, Hanny , Osman, Omar, Borghol, Abdul Hamid , Gudura, Tariku T., Herlitz, Leal, Cohen, Scott, Gebreselassie, Surafel , Bobart, Shane A. , Gudura, Tariku Tadele, Mehdi, Ali
No container title available | July 5, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract Background: Fibrillary glomerulonephritis (FGN) is a rare immune-mediated glomerular disease characterized by glomerular fibrillar deposits and historically associated with poor kidney outcomes. Despite recent diagnostic advances, including DNAJB9 immunohistochemistry, the clinical spectrum, prognostic factors, and optimal management of FGN remain incompletely defined. Methods: We conducted a retrospective cohort study of patients with biopsy-proven FGN identified through the Cleveland Clinic Kidney Biopsy Epidemiology Project between January 2015 and March 2023. Results: Thirty patients met inclusion criteria. The cohort was predominantly female (70%) and white (86%), with a median age of 64 years. At the time of kidney biopsy, all patients had hypertension and acute or chronic kidney disease. Additional features included hematuria (76%), proteinuria (60%), and nephrotic syndrome (48%). Monoclonal protein was detected in 20% of cases. During a mean follow-up of 24 months (range 0–70 months; n = 13), 23% achieved partial remission, 23% had persistent disease, and 53% progressed to end-stage kidney disease (ESKD). Higher serum creatinine at biopsy was the only variable associated with progression to ESKD. Conclusion: FGN remains a rare glomerular disease with substantial risk of progression to kidney failure. This single-center cohort highlights the heterogeneous clinical presentation and generally poor kidney outcomes of FGN in the modern diagnostic era. Larger, multicenter studies are needed to refine prognostic stratification and guide evidence-based management strategies.
Rituximab or cyclosporine A for the treatment of membranous nephropathy: economic evaluation of the MENTOR trial
So, Helen , Fervenza, Fernando C. , Cattran, Daniel C., Barbour, Sean J. , Investigators, MENTOR Study, Cattran, D C, Appel, Gerald B., Gipson, D, Erickson, Stephen B., Radhakrishnan, Jay, Bomback, A.S., Hogan, Jonathan, Arora, Neha , Nargund, Preeti, Alvarado, Anthony, Hebert, Lee A., Aslam, Nabeel , Porter, Ivan E. , Gipson, Patrick E., Plattner, Brandon L. , Gipson, D, Mariani, Laura , Garg, Pranay, Jefferson, J. Ashley , Nelson, Peter J. , Yarlagadda, Sri G. , Simon, James F. , Gebreselassie, Surafel , Blumenthal, Stanley A., Thomas, L, Cohen, Irvin M., Keddis, Mira T. , Sussman, Andrew L. , Thajudeen, Bijin , Fülöp, Tibor , Craici, Iasmina , Wagner, Steven J., DREISBACH, A, Monga, D., Green, D, Nayer, Ali, Thomas, D. B., Cattran, D C, Reich, Heather N. , Barbour, S. Lee , Philibert, D., Mac‐Way, Fabrice , Desmeules, Simon, Ankawi, Ghada , Sethi, Sanjeev , Ávila-Casado, Carmen , Beanlands, Heather , Fervenza, Fernando C , Kadatz, Matthew , Klarenbach, Scott W , Investigators, MENTOR Study, Cattran, D C, Gipson, D, Kretzler, Matthias , Rovin, Brad H. , Lieske, John C. , Leung, Nelson , Canetta, Pietro A. , Ahn, W, Lafayette, Richard , Arora, N, Parikh, Samir M. , Plattner, B, Gipson, D, Rao, P, Sedor, John R. , O'Toole, J, McCarthy, E, Jain, Namrata Gargee , Rizk, D, Blumenthal, S, Beara‐Lasić, Lada , Zhdanova, Olga A. , Thomas, L, Sussman, A, Juncos, Luis A. , Fulop, T, Monga, D, Mattiazzi, Adela D. , Thomas, D, Barisoni, Laura , Li, T, Vijayan, Anitha , Cattran, D C, Hladunewich, Michelle , Barbour, S, Levin, Adeera , Philibert, D
Nephrology Dialysis Transplantation | April 13, 2024 | Volume: 39 | Issue: 12 | Pages: 2058-2066
ABSTRACT Background and hypothesis The MENTOR trial (MEmbranous Nephropathy Trial Of Rituximab) showed that rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria and was superior in maintaining proteinuria remission. However, the cost of rituximab may prohibit first-line use for some patients and health-care payers. Methods A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of rituximab compared with cyclosporine for the treatment membranous nephropathy from the perspective of a health-care payer with a lifetime time horizon. The model was informed by data from the MENTOR trial where possible; additional parameters including cost and utility inputs were obtained from the literature. Sensitivity analyses were performed to evaluate the impact of reduced-cost biosimilar rituximab. Results Rituximab for the treatment of membranous nephropathy was cost effective (assuming a willingness-to-pay threshold of $50 000 per quality-adjusted life year (QALY) gained; in $US 2021) compared with cyclosporine, with an ICER of $8373/QALY over a lifetime time horizon. The incremental cost of rituximab therapy was $28 007 with an additional 3.34 QALYs compared with cyclosporine. Lower cost of rituximab biosimilars resulted in a more favorable ICER, and in some cases resulted in rituximab being dominant (lower cost and great benefit) compared to cyclosporine. Conclusions Despite the greater cost of rituximab, it may be a cost-effective option for the treatment of membranous nephropathy when compared with cyclosporine. The cost-effectiveness of rituximab is further improved with the use of less expensive biosimilars.