Successful Use of Single-Dose Rituximab for the Maintenance of Remission in a Patient with Steroid-Resistant Nephrotic Syndrome

Minimal change disease (MCD) is the etiology of 10%-25% of cases of nephrotic syndrome in adults. The mainstay of treatment for adult MCD, oral gucocorticoids, is based on two randomized controlled trials and extensive observational data in adults, and this treatment leads to remission in over 80% of cases. Relapses are common, and some patients become steroid-resistant (SR), steroid-dependent (SD), or frequently relapsing (FR). The data guiding the treatment of these patients are limited. Here, we review MCD in adults with particular focus on the evidence for immunosuppressive therapy in these patients.

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“…[69][70][71][72][73][74][75][76][77][78][79] These studies indicate that response to treatment is associated with peripheral B cell depletion.…”

Section: Rituximabmentioning

confidence: 99%

The Treatment of Minimal Change Disease in Adults

Hogan

Radhakrishnan

2013

Journal of the American Society of Nephrology

133

123

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“…Rituximab therapy (375 mg/m 2 body surface area per session) was administered once weekly for four weeks according to the recommended dosage for patients with B-cell lymphoma or autoimmune diseases (11,12). The successful use of singledose rituximab therapy has been reported in some patients previously exhibiting minimal changes (13)(14)(15). In patients with membranous nephropathy, four weekly infusions are generally accepted and achieve a good response (16,17).…”

Section: Table Laboratory Findings On Admissionmentioning

confidence: 99%

Rituximab Treatment for Adult Purpura Nephritis with Nephrotic Syndrome

et al. 2013

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The case of a 68-year-old woman with purpura nephritis associated with nephrotic syndrome is herein described. The patient's clinical course and the findings of a renal biopsy study revealed purpura nephritis. Following treatment with corticosteroids and intravenous cyclophosphamide accompanied by an angiotensin II type I receptor-blocker, an anti-platelet drug and an hydroxymethylglutaryl (HMG)-CoA, the proteinuria mildly decreased. Additional rituximab therapy led to a complete remission. This report describes our successful experience using rituximab to treat refractory nephrotic syndrome of purpura nephritis. Further studies are required to confirm the efficacy of rituximab as an alternative therapy for nephrotic syndrome.

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“…These initial findings were corroborated by a number of other case reports and retrospective and prospective studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Rituximab generally induced sustained remission allowing for a marked reduction or discontinuation of corticosteroids and/or immunosuppressive drugs in patients with MCD who were steroid dependent or frequent relapsers (24).…”

Section: Discussion Of Casementioning

confidence: 57%

“…Losartan 50 mg/d, orally B. Prednisone 1 mg/kg per day, orally for .4 months C. Cyclosporine 3.5-5 mg/kg per day orally, with trough blood levels of 125-175 ng/ml D. MMF 1g, orally, twice a day E. Sirolimus 5 mg/d, orally, with trough blood levels [12][13][14][15][16][17][18][19][20] ng/ml Discussion of Case 2, Question 2B In this patient, the absence of NS and focal foot process effacement on EM makes FSGS most likely to be secondary and should be treated conservatively, aiming to control BP and reduce proteinuria using inhibitors of the reninangiotensin system rather than immunosuppressive therapy. For this reason, treatment with losartan is the most appropriate of the options given (choice A is correct) ( Figure 5).…”

Section: Question 2bmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2013

Fervenza

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

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The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories, along with single best answer questions, were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the NQ&Q was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responses and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for CJASN readers. Enjoy the clinical cases and expert discussions.

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Successful Use of Single-Dose Rituximab for the Maintenance of Remission in a Patient with Steroid-Resistant Nephrotic Syndrome

Abstract: We present the case of a 23-year-old

Cited by 27 publications

References 11 publications

The Treatment of Minimal Change Disease in Adults

The Treatment of Minimal Change Disease in Adults

Rituximab Treatment for Adult Purpura Nephritis with Nephrotic Syndrome

American Society of Nephrology Quiz and Questionnaire 2013

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