title: Recurrent idiopathic membranous nephropathy in the renal allograft: successful treatment with the anti-CD20 monoclonal antibody rituximab.
abstract: Idiopathic membranous glomerulonephritis (IMGN) is one of the most common causes of nephrotic syndrome in adults. Disease progression is associated with the magnitude and duration of proteinuria [Reichert LJ, Koene RA, Wetzels JF. Prognostic factors in idiopathic membranous nephropathy. Am J Kidney Dis 1998; 31: 1-11]. Membranous nephropathy is also one of the glomerular diseases that is well described to recur in the transplanted kidney [Kotanko P, Pusey CD, Levy JB. Recurrent glomerulonephritis following renal transplantation. Transplantation 1997; 63: 1045]. There is no definitive therapy for primary membranous glomerulonephritis or recurrent disease in the graft. Cyclophosphamide plus steroids or cyclosporine [Cattran DC, Greenwood C, Ritchie S et al. Canadian Glomerulonephritis Study Group. A controlled trial of cyclosporine in patients with progressive membranous nephropathy. Kidney Int 1995; 47: 1130-1135] have been the preferred agents for the treatment of MGN involving the native kidneys. More recently, several reports have described the use of the anti-CD20 monoclonal antibody rituximab in patients with IMGN. In the current report, we present a patient with ESRD secondary to IMGN who developed nephrotic range proteinuria 5 months after receiving a kidney transplant from a deceased donor. A biopsy of the allograft demonstrated changes compatible with recurrent membranous glomerulonephritis. The patient was treated with four weekly infusions of rituximab over a 1-month period with a significant decrease in proteinuria and an improvement in renal function.
authors.affiliation: Division of Nephrology and Hypertension, Miller School of Medicine , University of Miami , Rosenstiel Medical Science Building, 1600 NW 10th Ave, Suite 7168, Miami, FL, 33136 , USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Ladino
authors.affiliation: Division of Nephrology and Hypertension, Miller School of Medicine , University of Miami , Rosenstiel Medical Science Building, 1600 NW 10th Ave, Suite 7168, Miami, FL, 33136 , USA.
authors.forename: David
authors.initials: D
authors.lastname: Roth
keywords: proteinuria; recurrent membranous nephropathy; renal allograft; rituximab