ESPN 50th Annual Meeting

ESPN 2017


 
Efficacy of Rituximab in a case of primary membranous nephropathy
NIKOLETA PRINTZA 1 STELLA STABOULI 1 JOHN DOTIS 1 IRENI GEORELI 1 OLGA MALIAHOVA 1 CHRISTINA SIDIRA 1 FOTIOS PAPACHRISTOU 1

1- 1ST PEDIATRIC DEPARTMENT, ARISTOTLE UNIVERSITY, THESSALONIKI, GREECE
 
Introduction:

Objectives: To present the efficacy of Rituximab in a case of primary membranous nephropathy, refractory to usual treatment protocols.

Material and methods:

Methods: Use of Rituximab in a single dose of 375 mg/m2

Results:

Results: A 12 years - old girl, presented with severe edema, proteinuria (10g/m2/24h), hypoalbuminemia (albumin 1.53 g/dl) and hyperlipidemia, with normal renal function. Nephrotic syndrome revealed steroid resistance and renal biopsy showed membranous nephropathy (MN). Investigation for an underlying systemic disease or infection was negative. Treatment with cyclosporine in a dose of 4 mg/kg/day in combination with prednisone on alternate days and lisinopril for 12 weeks failed as nephrotic range proteinuria persisted and the patient continued to be dependent to human albumin infusions. Therefore, alteration of treatment approach was decided into a combination of cyclophosphamide, prednisone on alternate day and lisinopril for 9 weeks with no clinical or laboratory response. After an overall period of treatment for 28 weeks the patient still presented heavy proteinuria and hypoalbuminemia and we decided to use rituximab. Rituximab was given to a single dose of 375 mg/m2 in combination with cyclosporine, lisinopril and prednisone on alternate day. One week later the number of CD20 B lymphocytes was reduced to zero. Proteinuria gradually decreased and complete remission was achieved in a period of 2 months after rituximab infusion. Today 12 months after the single rituximab infusion the number of CD 20 B lymphocytes remains zero and the patient is still in complete remission.

Conclusions:

Conclusions: In our case Rituximab was more effective to other treatment protocols to achieve initial remission. However it is still not clear if a combination of cyclosporine and minor steroids dose is a sufficient treatment to keep patient clear of proteinuria or the increase of B-cells will be accompanied by relapse of proteinuria indicating that patient is “rituximab depended”.