Rituximab treatment of dysproteinemias affecting the kidney: a review of three cases.
The renal diseases associated with monoclonal immunoglobulin deposits constitute a diverse range of clinical and pathological entities. Renal prognosis is variable, and there currently are no standard treatment regimens. We describe the effect of rituximab treatment on 3 patients with renal insufficiency and proteinuria with monoclonal immunoglobulin deposits associated with glomerulonephritis on renal biopsy. Two patients with hypertension and chronic lymphocytic leukemia had a membranoproliferative glomerulonephritis pattern on kidney biopsy associated with monoclonal immunoglobulin G deposits. Both patients experienced partial remission of their disease and 1 patient was able to come off hemodialysis therapy after treatment with 7 and 11 biweekly doses of rituximab, 375 mg/m(2), in addition to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker. Both patients subsequently experienced relapse of their hematologic and renal diseases and eventually progressed to end-stage renal disease and death. A third patient had diffuse proliferative glomerulonephritis with immunoglobulin G lambda deposits on renal biopsy. She was treated with an angiotensin receptor blocker and two 1,000-mg infusions of rituximab separated by 2 weeks, with sustained partial remission at 18 months' follow-up. Rituximab therapy, in addition to corticosteroids and angiotensin blockade, may improve the clinical course of patients with renal diseases associated with dysproteinemias, delaying the onset of end-stage renal failure or other adverse outcomes. Additional clinical studies should be planned.
Bhat
Premila
P
Department of Medicine (Nephrology), Columbia University Medical Center, New York, NY, USA.
Weiss
Stacey
S
Appel
Gerald B
GB
Radhakrishnan
Jai
J
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D007674:Kidney Diseases / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy* / Q000503:physiopathology; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000503:physiopathology; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab