Protocol biopsies for focal segmental glomerulosclerosis treated with plasma exchange and rituximab in a renal transplant patient

Sakai, Ken; Takasu, J.; Nihei, Hiroshi; Yonekura, Tatsuro; Aoki, Yujirou; Kawamura, Takeshi; Mizuiri, Sonoo; Aikawa, Atsushi

doi:10.1111/j.1399-0012.2010.01279.x

Cited by 20 publications

(16 citation statements)

References 22 publications

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“…The use of RTX in primary FSGS in adults has had variable, but mostly negative results in small case series [90], [91] and [92]. However, it may be useful in treating posttransplant relapse [93], [94] and [95]. Interestingly, recent research has shown that RTX may have a direct effect on podocytes, regardless of its action on B-cells, and this could explain the beneficial effect of RTX in these nephrotic disorders that are not clearly associated with auto-antibodies [96].…”

Section: Focal Segmental Glomerulosclerosis and Minimal Change Diseasementioning

confidence: 99%

Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases

Kattah¹,

Fervenza²,

Roccatello³

2013

Autoimmunity Reviews

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Rituximab is a monoclonal antibody to the CD20 antigen on B-cells that was initially designed and approved for the treatment of non-Hodgkin's B-cell lymphoma in 1997.In the last 15 years, it has emerged as a potent immunosuppressant for many immune-mediated diseases, beginning initially with rheumatoid arthritis, and now extending into several other fields, including clinical nephrology. Based on recent large clinical trials, it is FDA-approved for the treatment of ANCA-associated vasculitis and continues to be studied in off-label usage for many glomerular diseases, including membranous nephropathy, lupus nephritis, and mixed cryoglobulinemia. It has been used as a treatment in nephrotic syndrome in children and adults, including both minimal change disease and focal segmental glomerulosclerosis. Given its efficacy, tolerability and safety profile in comparison to more conventional treatment regimens, RTX is rapidly emerging as a critical treatment modality in glomerular disease.

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Section: Focal Segmental Glomerulosclerosis and Minimal Change Diseasementioning

confidence: 99%

Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases

Kattah¹,

Fervenza²,

Roccatello³

2013

Autoimmunity Reviews

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“…Previous studies have focused on one specific type of recurrent GN and have been exclusively case reports or small case series [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. None have compared a rituximab-based regimen to a non-rituximab-treated regimen.…”

Section: Discussionmentioning

confidence: 99%

“…While there have been some reports of rituximab treatment failure for recurrent GN [5,10,15,20], the majority have yielded success with rates up to 100% compared to ours at 55% [4,6,7,8,9,11,12,13,14,16,17,18,19,21,22,23,24]. Case reports and series may result in publication bias and an artificially high inflation of reported success rates.…”

Section: Discussionmentioning

confidence: 99%

“…While the mechanism of rituximab for GN treatment is not fully elucidated, it likely influences the production of circulating permeability factors and antibodies directly on B-cells or indirectly via B-cells with the help of T-cells [3]. The few published case reports/series on rituximab-use post-transplant have included treatment of recurrent membranous nephropathy (MN) [4,5,6,7,8], focal segmental glomerulosclerosis (FSGS) [4,9,10,11,12,13,14,15,16,17,18,19,20], membranoproliferative glomerulonephritis (MPGN) [4,21,22], IgA nephropathy (IgAN) [4], and Wegener's granulomatosis (WG) [23]. The results have yielded variable success.…”

Section: Introductionmentioning

confidence: 99%

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Single-Dose Rituximab for Recurrent Glomerulonephritis Post-Renal Transplant

et al. 2015

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Background/Aims: Post-renal transplant recurrent glomerulonephritis (GN) contributes to allograft loss. Rituximab treatment has been used in a multidose strategy with variable efficacy and toxicity. We investigated a novel single-dose approach. Methods: A single center, retrospective, cohort study was conducted between January 1998 and April 2012 among renal allograft recipients with recurrent GN treated with rituximab (cases) or without (controls). The primary outcome was complete response (CR, urine protein/creatinine ratio (UP/C) <0.3). Secondary outcomes included partial response (PR >50% reduction in UP/C), response relapse, treatment-response by GN type, acute rejection incidence, time to graft loss, and infection incidence. Results: The median dose of rituximab was 200 mg per patient. Of 20 rituximab cases and 13 controls, CR was achieved in eight (40%) versus four (31%), respectively (p = 0.72). Three subjects in each group achieved PR (p = 0.66). Response relapse was similar between the two groups (p = 0.47). Significantly more subjects with recurrent membranous nephropathy (MN) achieved CR with rituximab treatment (p = 0.029). Acute rejection was lower in the rituximab group versus controls (n = 0 vs. 4; p = 0.046). The mean time to graft loss was much later in the rituximab group (35 months, (95% CI 33-37)) versus controls (29 months, (95% CI 24-35)) at 36 months (p = 0.04). There was no infection increase in rituximab-treated subjects (p = 0.16). Conclusion: Single-dose rituximab for treatment of recurrent GN was associated with less subsequent rejection and longer time to graft loss without increased infection, but was no more effective than regimens not using rituximab at 36-months except those with recurrent membranous GN.

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“…Mixed reports of the efficacy of rituximab in renal transplantation patients with recurrent FSGS have been reported in reference 102-105 of the different approaches, only PEX with rituximab was associated with prolonged remission. 15,[105][106][107] In a recent study of 41 patients at high risk for recurrent FSGS, 27 of whom were treated with rituximab at time of kidney transplant, rituximab at time of kidney transplant was shown to prevent recurrent focal segmental glomerulosclerosis by modulating podocyte function in a sphingomyelin phosphodiesterase acid-like 3b-dependent manner. 15 Despite the paucity of data, combination of PEX and rituximab remains an acceptable treatment in patients with posttransplantation recurrent FSGS in many instances.…”

Section: Thrombotic Thrombocytopenic Purpuramentioning

confidence: 99%