title: Rituximab treatment for adults with refractory nephrotic syndrome: a single-center experience and review of the literature.
abstract: OBJECTIVE
  Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are common causes of nephrotic syndrome (NS) in adults. However, induction of remission and sustained control of proteinuria is often difficult. Recently, B cell-directed therapy using the anti-CD20 antibody rituximab has been suggested as induction regimen in pediatric FSGS and MCD patients. Data on rituximab use in adults are still limited.
  
  
  METHODS
  We report on rituximab use in five consecutively treated adult patients (mean age 42.2 ± 9.9 years) with FSGS or relapsing MCD (2 FSGS, 3 MCD) who failed to respond to standard immunosuppressive treatment. Median follow-up was 8 months (3-25).
  
  
  RESULTS
  Rituximab induced complete remission in 2 MCD patients and partial remission in 3 patients. Proteinuria was reduced by 86.8% (42.9-95.2) 3 months and by 73.0% (60.1-95.5) 6 months after therapy. In 1 patient with severe FSGS, partial remission was not evident before 6 months after rituximab treatment. Relapses occurred in 2 patients. No severe adverse events related to rituximab were observed.
  
  
  CONCLUSIONS
  Our findings suggest that B cell-directed therapies are novel treatment options for adults with refractory NS. Response to rituximab varied, with MCD patients exhibiting a faster and more pronounced response compared to FSGS patients.
authors.affiliation: Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.
authors.forename: Tuelay
authors.initials: T
authors.lastname: Kisner
authors.forename: Volker
authors.initials: V
authors.lastname: Burst
authors.forename: Sven
authors.initials: S
authors.lastname: Teschner
authors.forename: Thomas
authors.initials: T
authors.lastname: Benzing
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kurschat
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D000069283:Rituximab; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab