title: Treatment with rituximab in idiopathic membranous nephropathy.
abstract: BACKGROUND
  Rituximab represents a valid therapeutic option to induce remission in patients with primary glomerulonephritis. Despite several studies proving its efficacy in improving outcomes in patients with membranous nephropathy (MN), its role in therapeutic protocols is not yet defined.
  
  
  METHODS
  We studied 38 patients with idiopathic MN treated with rituximab (in 13 patients as first-line therapy, in the remaining 25 after conventional immunosuppressive therapy). The patients were analyzed for a 15-month median (interquartile range 7.7-30.2) follow-up, with serial monitoring of 24-h proteinuria, renal function and circulating CD19+B cells.
  
  
  RESULTS
  The percentages of patients who achieved complete remission, partial remission and the composite endpoint (complete or partial remission) were 39.5% (15 patients), 36.8% (14 patients) and 76.3% (29 patients), respectively. The 24-h proteinuria was reduced significantly during the entire period of follow-up (from a baseline value of 6.1 to 0.9 g/day in the last visit; P < 0.01), while albuminemia increased constantly (from a baseline value of 2.6 to 3.5 g/dL in the last observation; P < 0.01). Renal function did not significantly change during the observation period. Circulating CD19+B cells were reduced significantly from the baseline value to the 24-month value (P < 0.01); data about anti-phospholipase A2receptor antibodies were available in 14 patients, 10 of which experienced a decreasing trend after treatment. No significant adverse events were described during and after infusions.
  
  
  CONCLUSIONS
  The present study confirmed that treatment with rituximab was remarkably safe and allowed for a large percentage of complete or partial remissions in patients with MN.
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fiorentino
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tondolo
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bruno
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Infante
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandaliano
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy.
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.affiliation: Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Manno
keywords: glomerulonephritis; immunosuppression; membranous nephropathy; nephrotic syndrome; rituximab