Background There is no consensus regarding dose and frequency of rituximab in Nephrology with extrapolation of dose used in treating lymphoproliferative disorders. There are no guidelines on targeting initial and subsequent doses based on CD19 + B cells. Methods 100 mg rituximab was given initially in 42 adults with steroid dependent (SDNS) and frequently relapsing nephrotic syndrome (FRNS), idiopathic membranous nephropathy (MN) and high immunologic risk kidney transplantation. Absolute and percentage CD19 B cells and clinical status were assessed at baseline, days 30, 90, 180 and 1 year. Subsequent doses of rituximab were based on CD19 B cell reconstitution and clinical response. Results CD19 B cell percentage decreased from 16.3+7.6 to 0.3±0.3 (P=<0.001), 1.9±1.7 (P=<0.001) and 4.0±4.5 (P=0.005) by 30, 90 and 180 days respectively. Suppression of CD 19 B cell count below 1% at day 30, 90 and 180 was 40/42 (95.2%), 18/42(42.9%) and 7/42(16.7%) respectively. Of 30 with SDNS and FRNS followed up for one year, 29(96.7%) went into remission at day 30. Remission was sustained in 23(76.6%) at day 180 and 21(70%) at 1 year. There was significant decrease [P <0.001] in the dose of steroids needed to maintain remission at 180 days following rituximab (0.27±0.02mg/Kg to 0.02±0.00mg/Kg). CD 19 B cell percentage at 90 days correlated with relapse (P=0.001, OR 1.422, 95% CI 1.246-2.574). Eighteen (60%) required an additional dose. Of five with MN, four achieved remission by 6 months which was sustained in three by 1 year. Of the 7 kidney transplant recipients, 2 had antibody mediated rejections though CD19 B cells were suppressed even at one year. Conclusions Low dose rituximab induces sustained depletion of CD19 B cells up to 90 days. Its role in preventing relapses in SDNS, FRNS, MN and rejection needs further studies.

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Background and Aims Currently, the dose of rituximab used in nephrology practice is mostly extrapolated from the dose used in lymphoproliferative disorders. It is possible that a lesser dose may suffice when treating a non-neoplastic disorder. We conducted this study to study the clinical response and CD19 B cell suppression with a single dose of 100mg rituximab in nephrology practice Method This was a single center prospective study of role of 100mg rituximab as initial dose in steroid dependent (SDNS), frequently relapsing nephrotic syndrome (FRNS), idiopathic membranous nephropathy (MN) and high immunologic risk kidney transplantation with subsequent doses based on CD19 B cell reconstitution. Results Following 100mg rituximab in 42 patients, CD19 B cell percentage decreased from 16.3+7.6 to 0.3±0.3, 1.9±1.7 and 4.0±4.5 by 30, 90 and 180 days respectively. At 30th day, 40(95.2%) had CD19 B cell count &lt;1%. Of the 30 patients with SDNS and FRNS followed up for one year, 29(96.7%) went into remission at day 30. Remission was sustained in 23(76.6%) at day 180 and 21(70%) at 1 year. There was significant decrease [P &lt;0.001] in the dose of steroids needed to maintain remission at 180 days following rituximab (0.27±0.02mg/Kg to 0.02±0.00mg/Kg). Of the five patients with MN, four patients achieved remission by 6 months. Remission was sustained in three patients by 1 year. Of the 7 kidney transplant recipients, 2 had antibody mediated rejections though CD19 B cells were suppressed even at one year. Conclusion Low dose of 100 mg rituximab is sufficient to deplete CD19 B cells for up to 90days and is effective in inducing remission in SDNS and FRNS and MN. Targeting subsequent doses depending on CD19 B cell reconstitution may prevent relapses, limit toxicity and be cost effective.

Background and Aims Leptospirosis is a common zoonotic disease and acute kidney injury(AKI) is very commonly associated with it, often seen as a marker of disease severity. Renal replacement therapy(RRT) is often required in patients with clinical indications like uremia, oliguria, pulmonary edema and hyperkalemia. The two classical modalities employed for RRT are hemodialysis and peritoneal dialysis. We designed this study to evaluate the clinical outcome among patients with leptospirosis associated AKI requiring dialysis. Method: Basic clinical and demographic parameters of our patients were studied. The dialysis modality for each patient was decided based on their predominant clinical presentation. The duration of dialysis dependency and hospitalization along with final clinical outcome in terms of renal recovery or death were recorded. Appropriate statistical methods were used for analysis of results Results Thirty two patients underwent renal replacement therapy for leptospirosis associated AKI. Among them 22 received hemodialysis and 10 received peritoneal dialysis. Mortality in our group was 12.5%. Multiorgan involvement, need for mechanical ventilation and oliguric AKI were observed to be predictors of mortality along with hyperbilirubinemia, hypoalbuminemia, hyperkalemia and elevated creatinine phosphokinase levels. Peritoneal dialysis was observed to be associated with a shorter duration of dialysis dependency and hospitalization, however no significant impact on mortality was noticed. Conclusion Leptospirosis is a disease of great epidemiological significance in our part of the county. Prompt initiation of RRT in indicated patients leads to an acceptable clinical outcome with good renal recovery. Peritoneal dialysis is slowly losing popularity, which may be revived with proper training of medical personnel and good patient selection.