Abstract
BackgroundMinimal change disease is a common cause of nephrotic syndrome in adults. Higher relapse rate put patients at risk of steroids toxicity due to long-term exposure. Rituximab has been suggested to maintain long time remission and withdraw steroids and other immunosuppressants with fewer adverse events. However, optimal dose and dosing interval have not been explored.MethodsTwenty-five patients were enrolled from 2017-10 to 2020-03 in Nanfang Hospital in China. Clinical and biological data were extracted from medical records and laboratory databases. Therapy composed of 375mg/m2 rituximab once three weeks for 3 dose and corticosteroid was applied. Complete remission was defined as reduction of proteinuria to 0.3g/d. Remission rate, relapse rate, steroids used before and after rituximab therapy and adverse effects were documented at a mean time of 14.71 months.ResultsTwenty-two patients achieved complete remission for an average of 3.26 months and only 3 patients experienced one relapse respectively during the follow-up period. The mean remission maintenance time was 11.6 months, and was 5 months after steroids withdrawal. Steroids dose at last follow-up was 6.09mg/d, which was significantly reduced compared to 28.15mg/d before rituximab. Relapse rate before and after rituximab was 1.43 and 0.1, respectively. Only four minor adverse events were recorded.ConclusionsTherapy consisted of 375mg/m2 rituximab once three weeks for 3 dose combined with corticosteroid is effective in inducing remission in adult patients with minimal change disease. Both of the relapse rate and dose of steroids used are significantly decreased with fewer side effects.
Highlights
Minimal change disease is a common cause of nephrotic syndrome in adults
Most of the adult patients respond well to steroid treatment and the long-term prognosis is excellent with remission rate of 75-95% [4], longer remission time, higher tendency to relapse and higher incidence of acute kidney injury when compared with children, as well as no consensus on the optimal dose and duration of therapy, put adults at risk of prolonged exposure of steroids and other immunosuppressive agents [5, 6]
We aim to evaluate the efficacy of a regimen of 3 applications of 375mg/m2 dose of RTX three weeks apart together with steroids in adult patients with biopsy-proven Minimal change disease (MCD), and to show the relapse rate and discontinuation or tapering of steroids during the follow-up period after RTX therapy
Summary
Minimal change disease is a common cause of nephrotic syndrome in adults. Higher relapse rate put patients at risk of steroids toxicity due to long-term exposure. Minimal change disease (MCD) is a major cause of nephrotic syndrome (NS), presented as heavy proteinuria and hypoalbuminemia. It is diagnosed by the absence of glomerular lesions on light microscopy, negative immunofluorescence and extensive podocyte foot process effacement on electron microscopy in renal biopsy. Most of the adult patients respond well to steroid treatment and the long-term prognosis is excellent with remission rate of 75-95% [4], longer remission time, higher tendency to relapse and higher incidence of acute kidney injury when compared with children, as well as no consensus on the optimal dose and duration of therapy, put adults at risk of prolonged exposure of steroids and other immunosuppressive agents [5, 6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
