New Clinic Focuses on Glomerular Diseases

Cleveland Clinic has launched the Glomerular Diseases Clinic to provide multidisciplinary care that meets the unique needs of patients with glomerulonephritis, glomerulosclerosis and related conditions. It is one of only a handful of such programs in the United States.

The Glomerular Diseases Clinic is part of Cleveland Clinic’s nephrology program, which is ranked No. 2 in the nation by U.S. News & World Report’s “America’s Best Hospitals” survey. It is staffed by five nephrologists, James Simon, MD, Jonathan Taliercio, DO, Evamaria Anvari, MD, Juan Calle, MD, and Richard Fatica, MD. This team also meets about three times a month with a pathologist to review biopsies and treatment plans and to discuss advances in the field.

“We work as a multidisciplinary group,” says Dr. Simon.

Since many patients with lupus have glomerular disorders, Drs. Taliercio and Anvari will coordinate their care with Cleveland Clinic rheumatology specialists.

An unusual condition

Because glomerulonephritis is an unusual condition, few physicians develop expertise treating it, Dr. Simon says. Presenting symptoms can include high blood pressure, dark cola-colored urine, sudden swelling in the legs and fluid retention. Some patients lack symptoms and are referred after a test reveals protein or blood in their urine. Some patients self-refer seeking a second opinion.

“In the course of evaluating these patients, we often diagnose other conditions, such as cancer or hepatitis C, and we can refer to them to other Cleveland Clinic specialists to manage these conditions,” says Dr. Simon.

Patients generally are treated with immunosuppressant therapies such as prednisone.

Research studies

One major benefit of a dedicated glomerular disorders clinic is the access it provides patients to the latest clinical trials, Dr. Simon notes.

The Glomerular Disease Clinic staff is involved in several studies, including:

• MENTOR (Membranous Nephropathy Trial of Rituximab): Patients with idiopathic membranous nephropathy are randomly assigned to a trial of cyclosporine (given as a pill) or rituximab (given intravenously). The goal is to reduce protein loss in urine without encountering the risks typically associated with steroid therapy. Participants will be compared at 24 months (12 months after stopping the medication).
• ATHENA: This is an observational trial designed to characterize the natural decline of renal function markers such as glomerular filtration rate, creatinine, proteinuria and β-2 microglobulin in Alport syndrome patients. Simon is hopeful this study will lead to a drug trial within about a year.
• NEPTUNE (The Nephrotic Syndrome Study Network): This is an observational study of patients with nephrotic syndrome who undergo a medically indicated kidney biopsy. The primary study outcomes being followed are changes in the amount of urine protein and kidney function.

To refer a patient to Cleveland Clinic’s Glomerular Diseases Clinic, please call 855.REFER.123.