Name:Nouf Alyaseen
pediatric nephrology
Email: KSMC,neefan@hotmail.com
Name: Khalid Alsaran
pediatric nephrology
Email: KSMC,Kl-saran@moh.gov.sa
Name: Abdulaziz Alshathri
pediatric nephrology
Email: ksmc,aalshathri@moh.gov.sa
Name: Khalid mirza
pediatric nephrology
Email: ksmc,drmkhalid61@hotmail.com
Name: Wala felemban
pediatric nephrology
Email: walaa.felemban@gmail.com
Rituximab Treatment Outcomes in Children with Steroid Resistant Nephrotic Syndrome
Abstract
Background Idiopathic steroid resistant nephrotic syndrome (SRNS) in children is often difficult to treat. Calcineurin inhibitors comprise the first-line induction therapy but have significant side effects. Rituximab has been used successfully in treatment for refractory SRNS. Objectives To determine the efficacy and safety of rituximab for treating children with SRNS over a relatively long follow-up period. Patients and methods A retrospective cohort study was conducted as all children with idiopathic SRNS who failed to achieve remission after 4 weeks of prednisolone 60 mg/m2/day were enrolled. All patients underwent renal biopsies and genetic studies before rituximab treatment. Intravenous rituximab was administered weekly at 375 mg/m2 for four doses. Response to treatment was defined as maintaining remission with no relapse for 1 year. Results A total of 21 patients (male: female=15:6) were followed-up for 1 year. Twelve (57.1%) patients showed no relapse in the first year and six (28.6%) had no remission, but three (50%) of these six patients developed ESRD. The histopathological findings for the patients who respond to rituximab therapy (no relapse in the first 1 year) were: Focal segmental glomerulosclerosis“FSGS” (25%) and minimal change (66.7%). The histopathological findings for the patients who did not respond to rituximab therapy (no remission in the first year) were as follows: FSGS (83.3%) and diffuse change (16.7%). There were no side effects from rituximab therapy noted during the follow-up period. Conclusion Rituximab was found to be effective and relatively safe for idiopathic SRNS, but large controlled clinical trials with long-term follow-up are required for confirmation.
Keywords: Rituximab, Steroid Resistant Nephrotic Syndrome, Pediatric Nephrology, Immunosuppressive Therapy, Nephrotic Syndrome Outcomes, Childhood Kidney Disease, B-cell Depletion Therapy.
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