Abrogation of nephrotic proteinuria by rituximab treatment in a renal transplant patient with relapsed focal segmental glomerulosclerosis.
Relapse of focal segmental glomerulosclerosis (FSGS) after renal transplantation is 20-40%. Recurrence after a first relapse is 80%. The only current treatment is plasmapheresis and/or cyclophosphamide. We report successful treatment of a second relapse in a 48-year-old patient. At age 33, FSGS was diagnosed. The patient began hemodialysis 1 year later. In her first renal transplant, she developed recurrent FSGS and reached terminal transplant failure 3 years later. Eight years later, a second transplant was performed. Immunosuppressive regimen: steroids, mycophenolate mofetil (MMF), tacrolimus (TAC), and rabbit anti-thymocyte globulin. Proteinuria of 2-6 g/day was detected and a biopsy showed recurrent FSGS. Plasmapheresis was started without success. Another biopsy still showed FSGS. The patient received two doses of rituximab (375 mg/m2 each) i.v. Three weeks later, proteinuria was 350 mg/day (serum-creatinine 1.6 mg/dl). Twelve months later, proteinuria was at 90 mg/day. Rituximab might be an option for recurrent FSGS after renal transplantation.
Gossmann
Jan
J
Transplantationsambulanz, KfH Nierenzentrum, and Funktionsnereich Nephrologie, Medizinische Klinik III Klinikum der J.W. Goethe-Universitaet, Frankfurt, Germany.
Scheuermann
Ernst-Heinrich
EH
Porubsky
Stefan
S
Kachel
Heinz-Georg
HG
Geiger
Helmut
H
Hauser
Ingeborg A
IA
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001706:Biopsy; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000473:pathology / Q000652:urine; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000473:pathology; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence; D006435:Renal Dialysis; D012086:Reoperation; D000069283:Rituximab; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab