Experience of application of rituximab with resistant focal-segmental glomerulosclerosis in adults: a series of observations and a brief review of literature

Abstract

Steroid-resistant focal-segmental glomerulosclerosis (FSGS) with nephrotic syndrome (NS) is a progressive kidney disease with the rapid development of end-stage renal failure (ESRD). In recent years, attempts have been made to treat steroidresistant FSHS with anti-CD20 monoclonal antibodies, rituximab. Currently, only a few clinical case reports and series with contradictory results have been published. THE AIM of our study was to evaluate the effect of rituximab in patients with resistant to the therapy focal segmental glomerulosclerosis. MATERIALS AND METHODS : The study included 6 patients with confirmed diagnosis of FSGS. The inclusion criteria were the presence of steroid-resistant NS or to the other treatment regimens, including cyclosporin A, tacrolimus, mycophenolate mofetil, cyclophosphamide, and exclusion criteria were the secondary form of the disease. Patients were treated with one course of rituximab – 2 to 4 infusions (the total dose was 1.0–2.0 g). Laboratory parameters (daily proteinuria, albumin and eGFR CKD-EPI) were analyzed before rituximab, as well as 6 and 12 months after treatment. RESULTS : A partial remission of FSGS was achieved in one patient, stable renal function was maintained for 12 months follow-up. In 4 out of 6 patients, progression of the disease was observed with the development of ESRD in the period from 1 to 3 years, despite a decrease in the severity of NS. In one patient, the NS of the same severity persisted for 6 months after the treatment; no positive dynamics in proteinuria or serum proteins were observed. CONCLUSION : Thus, we did not show a significant effect of rituximab in patients with steroid-resistant FSGS. However, according to the literature the effect of rituximab has been achieved in approximately half of steroid-resistant FSGS cases, therefore further prospective clinical trials are needed.