Abstract
Rapidly progressive glomerulonephritis (RPGN) is a form of glomerulonephritis characterized by loss of renal function within weeks. Although a variety of underlying causes can trigger RPGN, the ultimate pathologic mechanism is the podocyte and epithelial activation leading to the crescent formation. Rituximab has been increasingly and successfully used for autoimmune conditions in recent years. Treatment of RPGN is based on the underlying condition, but specific clinical guidelines are lacking. In this article, we have tried to establish the role of rituximab in the management of patients with RPGN. All the studies we have used were found in the PubMed database, limited to studies involving adults. Animal studies and studies involving the pediatric population were excluded. The currently available literature does not support switching to rituximab as the first-line agent. It has failed to prove consistently superior to other medications. However, combined with other commonly prescribed treatment regimens, namely corticosteroids, with or without cytotoxic drugs, rituximab has shown efficacy in many studies. Therefore, we have concluded that the most prudent use of rituximab in patients with RPGN would be in those with disease refractory to standard management with corticosteroids and cytotoxic drugs or in those who have intolerable side effects. We believe that clinicians should keep reporting any cases of RPGN treated with rituximab so that a more clear pattern emerges and more exact treatment guidelines can be made.
Highlights
Progressive glomerulonephritis (RPGN), known as crescentic glomerulonephritis, is a form of glomerulonephritis characterized by rapid loss of renal function, usually within weeks [1]
All three types result in the activation of podocytes and epithelial proliferation in Bowman’s capsule and formation of crescents, which can be visualized on light microscopy [3,4,5]
They tend to respond to the same treatments as younger patients; the risk of side effects is higher, and age is considered an independent risk factor for adverse clinical outcomes [41,42]. These studies clearly point to the non-inferiority of rituximab compared to cyclophosphamide in the treatment of severe glomerulonephritis caused by ANCA-associated vasculitis
Summary
Progressive glomerulonephritis (RPGN), known as crescentic glomerulonephritis, is a form of glomerulonephritis characterized by rapid loss of renal function, usually within weeks [1]. They tend to respond to the same treatments as younger patients; the risk of side effects is higher, and age is considered an independent risk factor for adverse clinical outcomes [41,42]. These studies clearly point to the non-inferiority of rituximab compared to cyclophosphamide in the treatment of severe glomerulonephritis caused by ANCA-associated vasculitis. As recommended by Berden et al, therapies targeting T cells should be explored in the future
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