Objectives To describe the change in the incidence rates of primary and secondary FSGS from 1994 to 2013 in Olmsted County and to identify the clinical and biopsy characteristics that can help distinguish primary from secondary FSGS. Patients and Methods Olmsted County adult residents with native kidney biopsy between January 1, 1994 and December 31, 2013 and FSGS as the only glomerulopathy were identified. The clinical and pathological charachterstics of primary and secondary FSGS were described and compared. Incidence rates of primary and secondary FSGS over period of 1994–2013 were calculated. Results Among 370 adults biopsied during this period, 281 had glomerular diseases, of which 46 (16%) had FSGS. From 1994–2003 to 2004–2013, there was a significant increase in kidney biopsy rates (14.7; 95% CI, 12.1–17.3 vs. 22.9; 95% CI, 20.0–25.7 per 100,000 person-years, 17% increase per 5 years, P<.001) and total FSGS rates (1.4; 95% CI, 0.6–2.2 vs. 3.2; 95% CI, 2.1–4.3 per 100,000 person-years, 41% increase per 5 years, P=.02). Compared to patients with limited foot process effacement (<80%), patients with diffuse effacement (≥80%) without an identifiable cause had lower serum albumin (−0.7 g/dl, P<.001), higher proteinuria (+4.5 g/day, P<.001) and were more likely to have nephrotic syndrome (100% vs 4%, P<.001). Patients with diffuse effacement without an identifiable cause were classified as primary FSGS, which accounted for 3/12 (25%) of cases during 1994–2003 and 9/34 (26%) of cases during 2004–2013. Conclusion While the incidence of FSGS has increased, the proportions of primary and secondary FSGS have remained stable.

Rituximab is an anti-CD20 monoclonal antibody frequently used for the treatment of non-Hodgkin’s lymphoma, chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), and anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis. In addition, rituximab has recently been increasingly used as an off-label treatment in a number of inflammatory and systemic autoimmune diseases. It is advised that rituximab infusion may cause infusion reactions and adverse cardiac effects including arrhythmia and angina, especially in patients with prior history of cardiovascular diseases. However, its detailed cardiotoxicity profile and effects on cardiac function were not well described. We report a 51-year-old man who developed non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. The patient experienced reduced cardiac functions within 48 hours after the initial infusion, which remained markedly reduced at 9-month follow-up. As the utility of rituximab expands, physicians must be aware of this serious cardiovascular adverse effect.

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