title: Rituximab treatment of fibrillary glomerulonephritis.
abstract: Fibrillary glomerulonephritis belongs to a group of disorders characterized by pathogenic deposition of fibrils in glomeruli. This glomerulopathy tends to progress to end-stage kidney disease, and there currently are no treatments of proven benefit, including corticosteroids and cytotoxic agents. Because the glomerular deposits contain an immunoglobulin component, it was postulated that anti-B-cell therapy with rituximab, an anti-CD20 monoclonal antibody, may be effective in the treatment of patients with fibrillary glomerulonephritis. We describe 3 patients with fibrillary glomerulonephritis who were treated with rituximab for nephrotic-range proteinuria. Each patient also received standard antiproteinuria therapy, including blockade of the renin-angiotensin system and strict blood pressure control. All patients showed a decrease in proteinuria to less than 1.5 g/d of protein by 27 months, and kidney function was preserved throughout the duration of therapy and follow-up. No adverse effects were seen with rituximab. These outcomes suggest that treatment with rituximab may be a promising approach to the management of fibrillary glomerulonephritis, an entity previously considered refractory to therapy.
authors.affiliation: Ohio State University College of Medicine, Columbus, OH 43210, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: Miriam
authors.initials: M
authors.lastname: Chung
authors.forename: James
authors.initials: J
authors.lastname: Sloand
authors.forename: Bruce
authors.initials: B
authors.lastname: Goldman
authors.forename: Gerald
authors.initials: G
authors.lastname: Appel
authors.forename: Brad H
authors.initials: BH
authors.lastname: Rovin
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008875:Middle Aged; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab