title: Depletion of B lymphocytes in idiopathic membranous glomerulopathy: results from patients with extended follow-up.
abstract: OBJECTIVE
  To assess the long-term therapeutic benefit of temporary depletion of B lymphocytes in patients with idiopathic membranous glomerulopathy (MGN) and search for potential predictors of response.
  
  
  METHODS
  The patients included had been diagnosed with biopsy-proven MGN in the absence of secondary causes. Estimated glomerular filtration rate should be above 30 ml/min/1.73 m(2) and 24-hour proteinuria 3 g/day or more. Patients who had been treated with cyclosporine or cytotoxic agents the year prior to study entry were excluded. Depletion of B cells was achieved with rituximab, which was administered intravenously for 4 consecutive weeks. Partial remission was defined as a >50% decrease in proteinuria with absolute proteinuria <3 g/day, while complete remission was defined as a >50% decrease in proteinuria and an absolute protein excretion <0.3 g/day.
  
  
  RESULTS
  Twelve patients were studied (4 females/8 males) with a mean age of 51.3 years. No major adverse effects were observed. During a median follow-up time of 48 months, 11/12 (91.6%) patients achieved remission [7/12 (58.3%) complete remission and 4/12 (33.3%) partial remission], while 1 patient did not respond to therapy. Twelve months after therapy, 68.8% (p = 0.003) of cases had achieved partial and 28.4% complete remission. Measurements of lymphocyte subpopulations did not reveal any changes except for the B cell depletion. B cell infiltrates captured per mm(3) of renal tissue in the diagnostic biopsy did not correlate with subsequent response.
  
  
  CONCLUSIONS
  Depletion of B cells in idiopathic MGN was well tolerated and resulted in significant and long-lasting response rates in a series of 12 patients.
authors.affiliation: Nephrology and Transplantation Center, Laiko Hospital, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Lionaki
authors.forename: Smaragdi
authors.initials: S
authors.lastname: Marinaki
authors.forename: Lydia
authors.initials: L
authors.lastname: Nakopoulou
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Skalioti
authors.forename: Aliki
authors.initials: A
authors.lastname: Iniotaki
authors.forename: Petros P
authors.initials: PP
authors.lastname: Sfikakis
authors.forename: Costas
authors.initials: C
authors.lastname: Siamopoulos
authors.forename: John
authors.initials: J
authors.lastname: Boletis
keywords: B cell depletion; B lymphocytes; Idiopathic membranous glomerulopathy; Rituximab