Anti-CD20 monoclonal antibody (rituximab) for the treatment of recurrent idiopathic membranous nephropathy in a renal transplant patient.
Idiopathic membranous nephropathy (IMN) remains the most common histologic entity associated with adult-onset nephrotic syndrome. The therapy for IMN is challenging. Steroids and various other immunosuppressive agents have been tried in IMN; however, current agents have not altered the course of IMN, are nonspecific and can be very toxic. In native kidneys affected by IMN, rituximab, a monoclonal antibody against the B-cell surface antigen CD20, has been shown to reduce proteinuria and prevent disease progression. In this report, we describe a 39-year-old white male with end-stage renal disease secondary to IMN that, 4 months post living unrelated kidney transplant, developed recurrent IMN with 18 g/day of proteinuria. In addition to angiotensin converting enzyme inhibitor and statins, the patient was treated with 4 weekly doses of 375 mg/m2 of rituximab with significant reduction in proteinuria, a corresponding increase in serum albumin and improvement in hypercholesterolemia. At 3 years post-transplant, his kidney function remains stable with 0.5 g/day of proteinuria.
Gallon
L
L
Division of Nephrology, Northwestern University, Chicago, Illinois, USA. L-gallon@northwestern.edu
Chhabra
D
D
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005919:Glomerular Filtration Rate; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy; D011507:Proteinuria; D012008:Recurrence; D000069283:Rituximab; D012709:Serum Albumin / Q000032:analysis
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D012709:Serum Albumin; D000069283:Rituximab