title: Immunoadsorption: a new strategy to induce remission in membranous lupus nephritis.
abstract: We report the case of an 11-year-old previously healthy girl who presented for microscopic hematuria and nephrotic proteinuria with normal renal function, which persisted after 6 months of steroids, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers, hydroxychloroquine, mycophenolic acid and a low-salt diet. A serum investigation suggested lupus nephritis and a renal biopsy, performed 2 weeks after the first proteinuria detection, revealed membranous lupus nephritis. We decided to perform ten sessions of daily immunoadsorption. Proteinuria decreased significantly over these ten sessions from 8 to 0.12 g/l. After the tenth immunoadsorption session, the patient received the first rituximab (RTX) infusion leading to complete B-cell depletion. The patient was maintained on ACEi associated with mycophenolic acid and hydroxychloroquine. Three RTX reinjections were performed when CD19-positive cells reappeared in peripheral blood. Despite complete B-cell recovery and positive anti-dsDNA-Ab, the patient remained in complete remission 18 months after the initial diagnosis with negative proteinuria and a normal renal function.
authors.affiliation: Department of Pediatric Nephrology, APHP, DHU i2B Inflammation-Immunopathology-Biotherapy, Armand-Trousseau Hospital, Paris, France ; University Pierre and Marie Curie, Tenon Hospital, APHP, Paris, France.
authors.forename: Tim
authors.initials: T
authors.lastname: Ulinski
authors.affiliation: Department of Pediatric Nephrology, APHP, DHU i2B Inflammation-Immunopathology-Biotherapy, Armand-Trousseau Hospital, Paris, France ; University Pierre and Marie Curie, Tenon Hospital, APHP, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Davourie-Salandre
authors.affiliation: University Pierre and Marie Curie, Tenon Hospital, APHP, Paris, France ; Department of Pathology, Tenon Hospital, APHP, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brocheriou
authors.affiliation: Department of Pediatric Nephrology, APHP, DHU i2B Inflammation-Immunopathology-Biotherapy, Armand-Trousseau Hospital, Paris, France.
authors.forename: Bilal
authors.initials: B
authors.lastname: Aoun
keywords: Immunoadsorption; Membranous lupus nephritis; Proteinuria; Rituximab