Single low-dose rituximab for the treatment of steroid-resistant nephrotic syndrome with acute kidney injury

Abstract

The efficacy of rituximab for kidney disease, such as frequent relapsing nephrotic syndrome, has been reported recently. Herein, we report a case of a patient with acute kidney injury that was steroid-resistant nephrotic syndrome who responded to a single administration of lowdose rituximab. An 86-year-old Japanese woman with hypertension presented with severe peripheral edema within several days after onset. Due to the patient's age, renal biopsy was not performed, nephrotic syndrome was diagnosed and prednisolone was administered at 40 mg/day on the day after admission. However, anuria developed and hemodialysis was inevitably initiated on the 5th hospital day. The renal function did not recover, and the general condition gradually became aggravated. On the 50th hospital day, 100 mg rituximab was administered, which led to immediate depletion of CD20-positive cells. The urine volume gradually increased from 2-3 weeks after the rituximab administration, and the renal function recovered slightly. After 5 weeks, it became possible to wean the patient from dialysis, which had been applied for 3 months. Rituximab might be an option for the treatment of acute kidney injury due to steroid-resistant nephrotic syndrome.

The Efficacy and Safety of Rituximab for Childhood Steroid-Dependent Nephrotic Syndrome: A Systematic Review and Meta-Analysis

“…It was initially effective in the treatment of B-cell lymphoma, and then used to treat diseases like systemic lupus erythematosus, rheumatoid arthritis, and vasculitis (6). In recent years, scholars from many countries have used RTX as a treatment drug for children with NS and have achieved certain effects in treating childhood nephrotic syndrome (7)(8)(9). However, the efficacy and safety of RTX for this disease are still controversial, and the mechanism of action and safety in the disease are still unclear.…”

Clinical case of steroid-dependent nephrotic syndrome in a child

“…Спочатку він був ефективним при лікуванні В-клітинної лімфоми, а потім використовувався для лікування таких захворювань, як системний червоний вовчак, ревматоїдний артрит і васкуліт [5]. Останнім часом вчені з багатьох країн використовували RTX як препарат для лікування дітей з НС і досягли певних ефектів у лікуванні [6][7][8].…”