title: Rituximab therapy for Type I membranoproliferative glomerulonephritis.
abstract: OBJECTIVE
  Type I membranoproliferative glomerulonephritis (MPGN) is an immune-complex disease with a relatively poor prognosis. It has no established treatment in adults. Our hypothesis was that this disease would respond to B cell depletion with rituximab, an anti-CD20 monoclonal antibody.
  
  
  METHODS
  We conducted an openlabel trial, in Canada and the United States, of rituximab in 6 adult patients with Type I MPGN (4 idiopathic, 2 with cryoglobulinemia). The rituximab dose was 1,000 mg intravenously on Day 1 and on Day 15. The patients were followed for 1 year. The primary outcome was the change in proteinuria.
  
  
  RESULTS
  Peripheral blood B cells were suppressed, after rituximab, in all patients. The mean urinary protein excretion was 3.9 ± 2.0 g/d before treatment. Proteinuria fell in all patients, at all-time points, after rituximab administration. The difference was statistically significant (p < 0.05) at 6, 9 and 12 months, but not at 3 months. The minimum mean urinary protein excretion was 1.4 ± 1.4 g/d at 9 months. There were 2 complete and 3 partial remissions among the 6 patients. The creatinine clearance did not change significantly over the course of the study. There were no adverse effects.
  
  
  CONCLUSIONS
  Rituximab reduced proteinuria among patients with Type I MPGN. This trial suggests that B cells may play a role in this disease and that additional study of B-cell suppression is warranted.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. dillon.john@mayo.edu
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.forename: Michelle
authors.initials: M
authors.lastname: Hladunewich
authors.forename: William E
authors.initials: WE
authors.lastname: Haley
authors.forename: Heather N
authors.initials: HN
authors.lastname: Reich
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cattran
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Fervenza
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D002170:Canada; D003449:Cryoglobulinemia / Q000188:drug therapy; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000188:drug therapy; D000069283:Rituximab; D016896:Treatment Outcome; D014481:United States
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab