Use of rituximab in focal glomerulosclerosis relapses after renal transplantation.
BACKGROUND
Focal and segmental glomerulosclerosis (FSGS) accounts for more than 10% of all cases of renal diseases leading to renal failure in children. After renal transplantation, 20% to 40% of FSGS relapse, frequently leading to renal loss.Plasmapheresis is considered the first option to treat relapses by several authors but is often ineffective. The anti-CD20 monoclonal antibody rituximab has been proposed as a possible treatment.


METHODS
We reviewed the effect of rituximab in seven children or young adults with pretransplant FSGS and relapse of proteinuria after transplantation who did not respond to intensive plasmapheresis.


RESULTS
After treatment, urine protein disappeared in three patients, was reduced by 70% in one patient and by 50% in one patient. No response was observed in one patient who had a quick deterioration of renal function and reached end-stage renal failure after 3 months. One additional patient developed a severe reaction a few minutes after the start of the first rituximab infusion.


CONCLUSIONS
Rituximab is a possible option to treat some resistant cases of FSGS with relapsing proteinuria after transplantation. It is important that therapy is started early after evidence of failure of plasmapheresis, before sclerosis develops in the glomeruli. The response to treatment can occur after several months. During the follow-up period, CD19 cells should be monitored carefully, and additional rituximab infusions considered to maintain B-cell depletion.
Dello Strologo
Luca
L
Nephrology and Urology Department, Bambino Gesù Children's Hospital, Institute for Scientific Research, Piazza S. Onofrio 4, Rome, Italy. dellostrologo@opbg.net
Guzzo
Isabella
I
Laurenzi
Chiara
C
Vivarelli
Marina
M
Parodi
Angelica
A
Barbano
Giancarlo
G
Camilla
Roberta
R
Scozzola
Floriana
F
Amore
Alessandro
A
Ginevri
Fabrizio
F
Murer
Luisa
L
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19 / Q000032:analysis; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000517:prevention & control; D016030:Kidney Transplantation / Q000009:adverse effects*; D010956:Plasmapheresis; D011507:Proteinuria / Q000188:drug therapy / Q000276:immunology; D012008:Recurrence; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D007166:Immunosuppressive Agents; D000069283:Rituximab