Treatment with rituximab and hydroxychloroquine in a patient with membranous nephropathy and diabetic nephropathy: A case report

Abstract

Nephrotic syndrome (NS), which includes primary and secondary types, is one of the causes of end-stage kidney disease. Common causes in adults include diabetic nephropathy (DN), membranous nephropathy (MN), and focal segmental glomerulosclerosis. About 30%–40% of diabetics can develop into DN. The incidence of primary nephrotic syndrome in diabetic patients was not significantly different from that in the general population. Herein we present a windfall from the treatment of rituximab combined with hydroxychloroquine in a patient with primary MN and DN. A 51-year-old Chinese man, diagnosed with type 2 diabetes mellitus (T2DM) 12 years ago, was admitted to the hospital due to edema of bilateral lower limbs and severe proteinuria. Serology showed the obvious elevation of the anti-phospholipase A2 receptor (anti-PLA2R) level and renal biopsy showed MN concomitant with DN. After low dosage of prednisone and standard dosage of rituximab, the patient’s proteinuria decreased; however, the effect was unsatisfactory and proteinuria was elevated again in 8 months. Thus, treatment with rituximab and hydroxychloroquine was initiated, which resulted in proteinuria diminishing significantly and albumin returning to normal level. Therefore, even complicated with DN, patients diagnosed with primary MN still have a promising remission after being treated with rituximab and hydroxychloroquine.