Rituximab for Treatment of Focal Segmental Glomerulosclerosis in a Child: A Case Report

Abstract

Objective: To study the efficacy of rituximab in children with focal sclerosing glomerulonephritis (FSGS). Case Report: Before treatment, blood biochemistry, hepatic and renal function, differential white cell counts, immunoglobulins and the complement system were assessed. Promethazine (0.5-1 mg/kg) and methylprednisolone (0.1-0.3 mg/kg) were administered intravenously 30 min and 5-10 min before the rituximab infusion. Rituximab (0.27 g) was diluted in 300 ml glucose solution and initially administered at 50 ml/hr the rate increased to 50 ml/hr every 30 min after no side effects occurred in the first hour. A second dose was given one month later. During treatment, prednisone (30mg) was taken on alternate days. Benazepril (3.3 mg) was administered every day with one chongcao capsule. Homemade ershenkang was given three times a day. Outcome: Eyelid and limb edema declined two weeks after the first application of rituximab and resolved after the second treatment. Urinary protein levels decreases, serum albumin increased, and white cell counts, hepatic function and renal function remained constant. After 3 months of followup, urine protein decreased significantly, and serum albumin (35.2 g/L) and cholesterol (5.4 mmol/L) normalized. Parameters of immune activation also reduced, and the patient remained well. Conclusion: In this case, rituximab was a safe and efficacious treatment for FSGS.