title: Single dose of rituximab in children with steroid-dependent minimal change nephrotic syndrome.
abstract: Rituximab (RTX) can be used in children with nephrotic syndrome, particularly in those with steroid-dependent nephrotic syndrome (SDNS). However, at present there is no unified standard of how to use RTX, with regard to the amount of doses and frequency, in children with nephrotic syndrome. The study aimed to investigate the therapeutic efficacy of a single dose of RTX in children with steroid-dependent minimal change nephrotic syndrome (SD-MCNS). The patients with biopsy-proven minimal change disease (MCD) and clinical features of SDNS received a single dose of RTX (375 mg/m2). The toxicity and side effects of RTX were also observed. The study included 19 patients (10 males and 9 females). Follow-up of the patients was 1-50 months (28.1±16.6 months). B-cell depletion was achieved with RTX infusion (CD20<0.5%) and lasted 1-6 months (mean, 2.92±1.57 months). During follow-up, 10 patients remained in complete remission and did not relapse without administration of oral steroids or immunosuppressants for 4-50 months (mean, 30.1±12.6 months), despite recovery of the B-cell count. Nine patients relapsed in the process of reducing steroids, thus, treatment was maintained at a lower dosage (T=0, P<0.05) than prior to use of RTX. The number of relapses also decreased significantly (T=95, P<0.05). Five of the patients relapsed after stopping steroid for several months. At the end of follow-up, the efficacy of a single induction of RTX was 47.4% (9/19). There were no significant side effects associated with administration of RTX. In conclusion, RTX is a safe and effective alternative for children with SD-MCNS. RTX is an effective treatment for the rapid induction of remission and reduces relapse and steroid dependency. A single dose of RTX for children with SD-MCNS is recommended for rapid induction of remission, reduction of long-term steroid dosage, and decrease in the number of relapses, as it has few side effects.
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Niu
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Hao
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Ping
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Gui-Mei
authors.initials: GM
authors.lastname: Guo
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Xin-Yu
authors.initials: XY
authors.lastname: Kuang
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Guang-Hua
authors.initials: GH
authors.lastname: Zhu
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200062, P.R. China.
authors.forename: Wen-Yan
authors.initials: WY
authors.lastname: Huang
keywords: children; efficiency; minimal change disease; rituximab; steroid-dependent nephrotic syndrome