Use of rituximab in pediatric nephrology practice

Abstract

Materials and methods. The article presents the data on the analysis of case histories in 16 children with glomerulopathies who received treatment with rituximab in accordance with the diagnoses. Age of patients was 5 to 18 years, distribution by sex — 5 boys (31.3 %), 11 girls (68.8 %). Twelve children (75 %) received rituximab for frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and 4 (25 %) children for lupus nephritis. Results. In some cases, rituximab was prescribed against the background of glucocorticoids per os. Rituximab therapy followed a protocol with pre-administration of 1 mg/kg methylprednisolone or 100 mg hydrocortisone, followed by 15 mg/kg rituximab at a rate of approximately 50 ml/h using an infusion pump, which had previously been diluted with saline 1 mg/ml, with constant monitoring of the child’s condition. Rituximab was administered at least twice, two weeks apart. If necessary, after monitoring the level of CD20 in the blood serum, and in the presence of any number of cells or the preservation of the activity of the process, rituximab was administered again 6 months after the last injection. During treatment with rituximab, children who received glucocorticoids per os did not receive them, and the next day after the infusion they continued to receive them at the same dose. Nine children received concomitant therapy per os with an angiotensin-converting enzyme inhibitor at a renoprotective dose, which was not canceled on the days of rituximab infusion. During the administration of rituximab, two children reported adverse reactions in the form of a decreased blood pressure and tachycardia, which most likely occurred against the background of an increased rate of administration, and after stopping the infusion and a subsequent decrease in its rate, they disappeared. All other children tolerated rituximab well. The effectiveness of rituximab therapy was evaluated by the level of proteinuria, which at the baseline averaged 4.0 g/l, and after rituximab infusion, it averaged 0.5 g/l. Conclusions. Today, in the conditions of martial law in Ukraine and limited resources, the use of rituximab opens new opportunities in the treatment of nephrological pathology in children, acting as an alternative to the long-term use of glucocorticoids, simplifying treatment and reducing the number of side effects, especially in children with FRNS/SDNS and pathology-mediated AT (lupus nephritis). However, it is important to adhere to the protocol for rituximab administration and especially the rate of administration due to frequent adverse infusion reactions.