Rituximab for Kidney Disease

2019-02-01 17:31

Rituximab for Kidney DiseaseDo you know rituximab? For kidney patients with frequent relapse and refractory proteinuria, it shows remarkable effect. Now go on reading to learn more information on rituximab for kidney disease.

It is well known that chronic kidney disease is a difficult disease. Without effective treatment, there is a great risk of progression to uremia. In 10 to 20 years, 20% to 40% of IgA Nephropathy, 30% of membranous nephropathy, more than 50% of focal segmental glomerulosclerosis (FSGS) and membranous proliferative nephropathy will progress to uremia.

In order to alleviate massive proteinuria and prevent renal impairment, we often use glucocorticoids to treat nephropathy. But 60% of nephrotic syndrome is "refractory nephrotic syndrome": proteinuria does not alleviate after steroid use, or recurs frequently after remission.

Immunosuppressive agents, such as tacrolimus or cyclosporine A, are commonly used to treat steroid-resistant or frequently relapsed nephropathy. However, they have two shortcomings, one is that the apparent efficiency is not very high, some proteinuria can not be improved; the other is that side effects are large: nausea and vomiting, headache, fatigue, nephrotoxicity, hepatotoxicity, cancer risk, elevated blood potassium, blood sugar, blood lipid and so on.

When the effect of immunosuppressive agents is not ideal, biological agents - monoclonal antibodies (McAbs) may bring hope, such as rituximab, baliximab and infliximab. Today, I'd like to introduce Rituximab, one of the most prominent proteinuria-lowering agents, for the treatment of refractory nephropathy.

Rituximab for membranous nephropathy

One third of membranous nephropathy patients do not have significant improvement in proteinuria after conservative treatment, and eventually progress to renal failure or uremia, so many clinical trials begin to try rituximab.

In 2017, the nephrology team of Peking University hospital published a study: 36 patients with membranous nephropathy were treated with rituximab.

Prior to rituximab administration, these patients with membranous nephropathy had received steroids combined with cyclophosphamide, cyclosporine, tacrolimus, mycopenolate, leflunomide, etc. (for average 4 years), but still had high levels of proteinuria (> 3.5g). And most of them had kidney function averaging more than 177 mol/l.

After 12 months of median follow-up with rituximab, 41.7% of patients with refractory membranous nephropathy had partial or complete remission of urinary protein.

It is difficult to avoid uremic if routine treatment continues, and rituximab has pulled back nearly half of those with refractory membranous nephropathy.

Rituximab for Minimal Change Disease

In a recent study published in the journal JAMA Pediatrics, the Franz Schaefer team at the university of Heidelberg in Germany looked at rituximab in children with nephrotic syndrome. In children with nephrotic syndrome, 90% of them are minimal change disease.

The results showed that rituximab was better than tacrolimus in reducing steroid dosage and reducing recurrence rate, and had fewer side effects. The researchers said that rituximab is expected to be a first-line drug to reduce steroid therapy.

Other kidney disease

Rituximab is also an alternative second-line drug for other more refractory kidney diseases.

1. FSGS that urinary protein is difficult to decrease and progresses rapidly.

2. Type I membranous proliferative nephropathy that steroids and immunosuppressants mostly do not take effect and complications are too many.

3. ANCA-related vasculitis with high mortality and pulmonary infection is prone to renal damage.

4. Severe lupus nephritis with dangerous onset, frequent renal failure and even life-threatening activity;

Now you know that rituximab is good for some kidney patients. But you had better talk with your doctor about it. For more information on kidney disease treatment, please leave a message below or contact online doctor.

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