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Rituximab in adult patients with multi-relapsing/steroid-dependent minimal change disease and focal segmental glomerulosclerosis: a report of 5 cases

Rituximab bei erwachsenen Patienten mit häufig-relapsierender/steroid-abhängiger Minimal Change Disease und fokal segmentaler Glomerulosklerose: Ein Bericht von 5 Fällen

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Abstract

Background

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are common causes of nephrotic syndrome in children and adults. However, frequent relapses, steroid dependence, steroid resistance, and side effects of immunosuppressive therapy remain a therapeutic challenge. Rituximab (RTX) has evolved as an efficacious alternative in childhood MCD/FSGS. We report the effect of RTX in 5 adult patients with multirelapsing/steroid-dependent nephrotic syndrome due to MCD or FSGS.

Results

All five patients treated with RTX achieved sustained complete remission and additional immunosuppression was withdrawn. One patient had a relapse after 23 months, which was successfully treated with a further series of RTX infusion without reinitiation of steroid therapy. Serious adverse events related to RTX therapy were not observed in our patients.

Conclusions

Our results indicate that RTX is effective and cessation of additional immunosuppressants could be achieved in all patients reported in this study. RTX may be an effective alternative therapy in adult patients with multirelapsing/steroid-dependent nephrotic syndrome due to MCD or FSGS.

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References

  1. Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, et al. Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol. 2007;2(3):445–53.

    Article  CAS  PubMed  Google Scholar 

  2. Chun MJ, Korbet SM, Schwartz MM, Lewis EJ. Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants. J Am Soc Nephrol. 2004;15(8):2169–77.

    Article  PubMed  Google Scholar 

  3. Huang JJ, Hsu SC, Chen FF, Sung JM, Tseng CC, Wang MC. Adult-onset minimal change disease among Taiwanese: clinical features, therapeutic response, and prognosis. Am J Nephrol. 2001;21(1):28–34.

    Article  CAS  PubMed  Google Scholar 

  4. Philibert D, Cattran D. Remission of proteinuria in primary glomerulonephritis: we know the goal but do we know the price? Nat Clin Pract Nephrol. 2008;4(10):550–9.

    Google Scholar 

  5. Cattran DC, Appel GB, Hebert LA, Hunsicker LG, Pohl MA, Hoy WE, et al. A randomized trial of cyclosporine in patients with steroid-resistant focal segmental glomerulosclerosis. North America Nephrotic Syndrome study group. Kidney Int. 1999;56(6):2220–6.

    Article  CAS  PubMed  Google Scholar 

  6. Day CJ, Cockwell P, Lipkin GW, Savage CO, Howie AJ, Adu D. Mycophenolate mofetil in the treatment of resistant idiopathic nephrotic syndrome. Nephrol Dial Transplant. 2002;17(11):2011–13.

    Article  CAS  PubMed  Google Scholar 

  7. Al-Saran K, Mirza K, Al-Ghanam G, Abdelkarim M. Experience with levamisole in frequently relapsing, steroid-dependent nephrotic syndrome. Pediatr Nephrol. 2006;21(2):201–5.

    Article  CAS  PubMed  Google Scholar 

  8. Kemper MJ, Gellermann J, Habbig S, Krmar RT, Dittrich K, Jungraithmayr T, et al. Long-term follow-up after rituximab for steroid-dependent idiopathic nephrotic syndrome. Nephrol Dial Transplant. 2012;27(5):1910–5.

    Article  CAS  PubMed  Google Scholar 

  9. Prytula A, Iijima K, Kamei K, Geary D, Gottlich E, Majeed A, et al. Rituximab in refractory nephrotic syndrome. Pediatr Nephrol. 2010;25(3):461–8.

    Article  PubMed  Google Scholar 

  10. Hoxha E, Stahl RA, Harendza S. Rituximab in adult patients with immunosuppressive-dependent minimal chang. disease. Clin Nephrol. 2011;76(2):151–8.

    Article  CAS  PubMed  Google Scholar 

  11. Gulati A, Sinha A, Jordan SC, Hari P, Dinda AK, Sharma S, et al. Efficacy and safety of treatment with rituximab for difficult steroid-resistant and -dependent nephrotic syndrome: multicentric report. Clin J Am Soc Nephrol. 2010;5(12):2207–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Kisner T, Burst V, Teschner S, Benzing T, Kurschat CE. Rituximab treatment for adults with refractory nephrotic syndrome: a single-center experience and review of the literature. Nephron Clin Pract. 2012;120(2):c79–85.

    Article  CAS  PubMed  Google Scholar 

  13. Fernandez-Fresnedo G, Segarra A, Gonzalez E, Alexandru S, Delgado R, Ramos N, et al. Rituximab treatment of adult patients with steroid-resistant focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2009;4(8):1317–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Sugiura H, Takei T, Itabashi M, Tsukada M, Moriyama T, Kojima C, et al. Effect of single-dose rituximab on primary glomerular diseases. Nephron Clin Pract. 2011;117(2):c98–105.

    Article  CAS  PubMed  Google Scholar 

  15. Ochi A, Takei T, Nakayama K, Iwasaki C, Kamei D, Tsuruta Y, et al. Rituximab treatment for adult patients with focal segmental glomerulosclerosis. Intern Med. 2012;51(7):759–62.

    Article  CAS  PubMed  Google Scholar 

  16. Moghadam-Kia S, Werth VP. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. 2010;49(3):239–48.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Peters HP, van de Kar NC, Wetzels JF. Rituximab in minimal change nephropathy and focal segmental glomerulosclerosi: report of four cases and review of the literature. Neth J Med. 2008;66(10):408–15.

    CAS  PubMed  Google Scholar 

  18. Yang T, Nast CC, Vo A, Jordan SC. Rapid remission of steroid and mycophenolate mofetil (mmf)-resistant minimal change nephrotic syndrome after rituximab therapy. Nephrol Dial Transplant. 2008;23(1):377–80.

    Article  PubMed  Google Scholar 

  19. Francois H, Daugas E, Bensman A, Ronco P. Unexpected efficacy of rituximab in multirelapsing minimal change nephrotic syndrome in the adult: first case report and pathophysiological considerations. Am J Kidney Dis. 2007;49(1):158–61.

    Article  CAS  PubMed  Google Scholar 

  20. Beco A, Castro-Ferreira I, Coentrao L, Neto R, Sampaio S, Pestana M. Rituximab for steroid-dependent nephrotic syndrome. Clin Nephrol. 2010;74(4):308–10.

    CAS  PubMed  Google Scholar 

  21. Kurosu N, Sugiura H, Iwasaki C, Asamiya Y, Kojima C, Moriyama T, et al. Successful use of single-dose rituximab for the maintenance of remission in a patient with steroid-resistant nephrotic syndrome. Intern Med. 2009;48(21):1901–04.

    Article  PubMed  Google Scholar 

  22. Amemiya N, Takei T, Kojima C, Nokiba H, Itabashi M, Nitta K. Induction of remission following a single dose of rituximab alone in a patient with minimal change nephrotic syndrome. Clin Exp Nephrol. 2011;15(6):933–6.

    Article  PubMed  Google Scholar 

  23. Bitzan M, Anselmo M, Carpineta L. Rituximab (B-cell depleting antibody) associated lung injury (RALI): a pediatric case and systematic review of the literature. Pediatr Pulmonol. 2009;44(9):922–34.

    Article  PubMed  Google Scholar 

  24. Datta SK. Anti-CD20 antibody is an efficient therapeutic tool for the selective removal of autoreactive T cells. Nat Clin Pract Rheumatol. 2009;5(2):80–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Fornoni A, Sageshima J, Wei C, Merscher-Gomez S, Aguillon-Prada R, Jauregui AN, et al. Rituximab targets podocytes in recurrent focal segmental glomerulosclerosis. Sci Transl Med. 2011;3(85):85ra46.

    Google Scholar 

  26. Wilk E, Witte T, Marquardt N, Horvath T, Kalippke K, Scholz K, et al. Depletion of functionally active CD20 + T cells by rituximab treatment. Arthritis Rheum. 2009;60(12):3563–71.

    Article  CAS  PubMed  Google Scholar 

  27. Meyrier AY. Treatment of focal segmental glomerulosclerosis with immunophilin modulation: when did we stop thinking about pathogenesis? Kidney Int. 2009;76(5):487–91.

    Article  PubMed  Google Scholar 

  28. Kanai T, Shiraishi H, Yamagata T, Ito T, Odaka J, Saito T, et al. Th2 cells predominate in idiopathic steroid-sensitive nephrotic syndrome. Clin Exp Nephrol. 2010;14(6):578–83.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest


The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Andreas Kronbichler MD,  Paul König,  Gert Mayer & Michael Rudnicki MD

  2. Department of Internal Medicine III, University Hospital Jena, Jena, Germany

    Martin Busch MD &  Gunter Wolf

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  1. Andreas Kronbichler MD
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  2. Paul König
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  3. Martin Busch MD
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  4. Gunter Wolf
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  5. Gert Mayer
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  6. Michael Rudnicki MD
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Correspondence to Andreas Kronbichler MD.

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Kronbichler, A., König, P., Busch, M. et al. Rituximab in adult patients with multi-relapsing/steroid-dependent minimal change disease and focal segmental glomerulosclerosis: a report of 5 cases. Wien Klin Wochenschr 125, 328–333 (2013). https://doi.org/10.1007/s00508-013-0366-7

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  • DOI: https://doi.org/10.1007/s00508-013-0366-7

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