Abstract
Minimal change disease (MCD) is a common cause of nephrotic syndrome, and steroid treatment is usually effective at the expense of adverse effects and frequent relapses. Rituximab, a monoclonal antibody against cluster of differentiation (CD)20 B-lymphocytes, leads to depletion of B-cells and has been frequently used to treat relapsing MCD in children. The efficacy of rituximab in treating adult MCD is limited. We report our experience with the use of rituximab for adult biopsy-proven MCD.Our series includes four adult patients (two males and two females), aged 22-80 years, treated with rituximab. All four patients achieved a complete remission with rituximab which lasted from 12 to 19 months. No adverse events from rituximab were observed. This shows the remarkable efficacy of rituximab in the treatment of minimal change disease in adults and may be preferred in patients at high risk for the development of adverse events from corticosteroids.
Highlights
Minimal change disease (MCD) is the most common primary nephrotic syndrome in children and accounts for 15% of adult nephrotic syndrome, of which 25% have a frequently relapsing course and 30% become steroid dependent [1]
Renal pathology showed more than 50% podocyte effacement consistent with MCD
We have a male patient who was diagnosed with MCD at the age of 22 years with renal biopsy showing acute tubular injury, mild mesangial expansion, mesangial IgA(3+), C3 (2+), IgM (2+), IgG (1 +), and severe foot process effacement on electron microscopy. He was initially treated with prednisone 1 mg/kg but developed frequent relapses with steroid tapering. He received a dose of rituximab of 375 mg/m2 after which his urine albumin-creatinine ratio (UACR) improved from 4600 mg/g to 120 mg/g, and he has been in remission for 14 months
Summary
Minimal change disease (MCD) is the most common primary nephrotic syndrome in children and accounts for 15% of adult nephrotic syndrome, of which 25% have a frequently relapsing course and 30% become steroid dependent [1]. We have a male patient who was diagnosed with MCD at the age of 22 years with renal biopsy showing acute tubular injury, mild mesangial expansion, mesangial IgA(3+), C3 (2+), IgM (2+), IgG (1 +), and severe foot process effacement on electron microscopy. He was initially treated with prednisone 1 mg/kg but developed frequent relapses with steroid tapering. He received a dose of rituximab of 375 mg/m2 after which his UACR improved from 4600 mg/g to 120 mg/g, and he has been in remission for 14 months. ACR: albumin-creatinine ratio; LM: light microscopy; EM: electron microscopy; ATI: acute tubular injury
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