Rituximab Treatment for Adult Purpura Nephritis with Nephrotic Syndrome

Ishiga, Hiroaki; Hashimoto, Tatsuo; Akata, Mariko; Suzuki, Shota; Azushima, Kengo; Kobayashi, Yusuke; Kanaoka, Tomohiko; Yoshida, Shinichiro; Wakui, Hiromichi; Oshikawa, Jin; Nagahama, Kiyotaka; Inayama, Yoshiaki; Tamura, Kouichi; Toya, Yoshiyuki; Umemura, Satoshi

doi:10.2169/internalmedicine.52.9325

Cited by 18 publications

(10 citation statements)

References 17 publications

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“…Cases 1–3 had low-grade albuminuria (<250 mg/day), in one of these even decreasing during pregnancy when ACEi had to be stopped. Our positive results are in line with earlier reports on RTX therapy in IgAV and in recurrent IgAN after renal transplantation [10–12, 14, 18, 19]. However, Sugiura et al [13] did not find any proteinuria reduction 6 months after single-dose RTX in 5 non-nephrotic IgAN patients.…”

Section: Discussionsupporting

confidence: 92%

“…Recently the efficacy of OFAB was demonstrated in five children with nephrotic syndrome resistant to conventional therapy and RTX [9]. A few case reports have been published on the positive treatment effects of RTX in IgAVN but there is no information on the use of OFAB in this disease [10–12]. An earlier prospective study of single-dose RTX treatment on top of corticosteroids (CSs) in five patients with non-nephrotic IgAN showed no reduction of proteinuria after 6 months.…”

Section: Introductionmentioning

confidence: 99%

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B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

et al. 2016

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BackgroundApproximately 30% of adult patients with immunoglobulin A (IgA) nephropathy (IgAN) or IgA vasculitis with nephritis (IgAVN) develop end-stage renal disease during long-term follow-up. In particular, patients with nephritic–nephrotic syndrome have an increased risk of rapid progression. Conventional immunosuppressive therapy with corticosteroids (CSs) may be insufficient for disease control and is associated with a number of side effects. Rituximab (RTX) has been shown to be well tolerated and effective in a range of glomerular diseases, but there is little information on its therapeutic potential in IgAN. The humanized anti-CD20 monoclonal antibody ofatumumab (OFAB) may be an alternative drug for patients intolerant or unresponsive to RTX, but so far there is no report on its use in IgAVN or IgAN.MethodsWe describe clinical outcomes after 17–22 months in four adult patients with biopsy-confirmed IgAVN or IgAN treated with RTX or OFAB as well as CS soon after diagnosis. All presented with nephritic–nephrotic syndrome and one had crescentic IgAN. Rebiopsy was performed in two cases.ResultsRTX and OFAB were well tolerated. Albuminuria was <250 mg/day in three patients at last evaluation and two regained normal renal function. In all cases, renal function improved after therapy. In one patient with severe IgA vasculitis, rebiopsy showed disappearance of subendothelial but not mesangial immune complexes. In the case with crescentic IgAN, rebiopsy after 9 months showed no active necrotic lesions.ConclusionsB cell–depleting therapy may be an alternative treatment for patients with IgAN or IgAVN and nephritic–nephrotic syndrome. A possible CS-sparing effect should be further evaluated in randomized controlled clinical trials.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

et al. 2016

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“…Improvements of renal function are in line with earlier results on RTX therapy in nephropathies and in recurrent IgAN (13)(14)(15)(16)(17)(18). However, Sugiura et al (19) did not find any proteinuria reduction after singledose rituximab in five non-nephrotic IgAN patients.…”

Section: Rituximab For Improvement Of Renal Function In Igansupporting

confidence: 70%

Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

Tamadon¹,

Moghimi²,

Rezaei³

2017

J Nephropathol

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Implication for health policy/practice/research/medical education:Several recently randomized clinical trials underline the substantial risk of side effects and the lack of proven efficacy with all kinds of immunosuppressive treatment including rituximab. In concordance, other studies observed a reduction of hematuria after RTX therapy. Please cite this paper as: Tamadon MR, Moghimi J, Rezaei H. Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts.

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“…Of the 10% who had presented with end-stage renal disease, the majority of patients underwent delayed treatment, hence early intervention may be necessary to prevent severe renal outcomes [54]. Cyclosporin A, rituximab, and mycophenolate mofetil have also been used to treat HSP nephritis [55,56,57]. …”

Section: Treatmentmentioning

confidence: 99%

Urological Manifestations of Henoch-Schonlein Purpura: A Review

et al. 2015

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Henoch-Schonlein purpura (HSP) is an immune-mediated systemic vasculitis generally found in children. The standard manifestations of HSP are palpable purpura, arthritis, abdominal pain, and renal complications. Although less common, there are significant urological manifestations associated with HSP. The primary objective of this review is to encourage better understanding and management of HSP by emphasizing the common and rare manifestations of HSP, how they are diagnosed, and the latest treatment options for mild to severe complications. Medline searches of HSP and its urological manifestations were conducted along with searches on current diagnostic and treatment methods. Urological manifestations of HSP involve the kidney, ureter, bladder, prostate, scrotum, testicle, and penis. Diagnosis and management of HSP are not always clear due to differential diagnosis and diversity of symptom presentation. Treatment for HSP is mainly supportive and includes use of nonsteroidal anti-inflammatory drugs for pain relief. In more severe cases, glucocorticoids, methylprednisolone, plasmapheresis, and peritoneal and hemodialysis are reported successful. It is important to note different symptoms of HSP in order to distinguish HSP from other diseases. Early diagnosis may prevent severe complications. Treatment options vary from conservative to invasive depending on the severity of the disease and time frame of diagnosis.

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Rituximab Treatment for Adult Purpura Nephritis with Nephrotic Syndrome

Cited by 18 publications

References 17 publications

B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

Urological Manifestations of Henoch-Schonlein Purpura: A Review

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