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Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine

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Abstract

Rituximab (RTX) has been successfully used as a rescue therapy in children with steroid-dependent nephrotic syndrome (SDNS). However, little is known regarding maintenance therapy after a successful response to RTX in such patients. The efficacy and safety of a single RTX infusion (375 mg/m2) were assessed in ten patients who had persistent SDNS associated with minimal-change disease (MCD) despite the long-term use of cyclosporine (CsA). The mean follow-up after RTX infusion was 17 months. Applying RTX resulted in a significant reduction in the mean prednisolone (PSL) dose from 0.39 ±0.18 to 0.15 ± 0.14 mg/kg per day. The mean 12-month relapse rates significantly decreased from 4.1 ± 1.7 to 0.6 ± 0.6. All but one patient who had continued CsA as maintenance therapy after a single RTX infusion were able to withdraw from PSL without any relapses during the study period, whereas the remaining five patients who discontinued CsA experienced relapses after CD19 cells re-emerged, leading to the reintroduction of CsA or an additional RTX infusion. Infusion reactions occurred in five of ten patients. These data indicate that a single RTX infusion may improve response to CsA in patients with persistent SDNS due to the phenomenon of secondary resistance to CsA.

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References

  1. Hodson EM, Alexander SI (2008) Evaluation and management of steroid-sensitive nephrotic syndrome. Curr Opin Pediatr 20:145–150

    Article  PubMed  Google Scholar 

  2. Kyrieleis HA, Levtchenko EN, Wetzels JF (2007) Long-term outcome after cyclophosphamide treatment in children with steroid-dependent and frequently relapsing minimal change nephrotic syndrome. Am J Kidney Dis 49:592–597

    Article  CAS  PubMed  Google Scholar 

  3. Okada M, Sugimoto K, Yagi K, Yanagida H, Tabata N, Takemura T (2007) Mycophenolate mofetil therapy for children with intractable nephrotic syndrome. Pediatr Int 49:933–937

    Article  CAS  PubMed  Google Scholar 

  4. Benz K, Dötsch J, Rascher W, Stachel D (2004) Change of the course of steroid-dependent nephrotic syndrome after rituximab therapy. Pediatr Nephrol 19:794–797

    Article  PubMed  Google Scholar 

  5. Smith GC (2007) Is there a role for rituximab in the treatment of idiopathic childhood nephrotic syndrome? Pediatr Nephrol 22:893–898

    Article  PubMed  Google Scholar 

  6. Gilbert RD, Hulse E, Rigden S (2006) Rituximab therapy for steroid-dependent minimal change nephrotic syndrome. Pediatr Nephrol 21:1698–1700

    Article  PubMed  Google Scholar 

  7. Guigonis V, Dallocchio A, Baudouin V, Dehennault M, Hachon-Le Camus C, Afanetti M, Groothoff J, Llanas B, Niaudet P, Nivet H, Raynaud N, Taque S, Ronco P, Bouissou F (2008) Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases. Pediatr Nephrol 23:1269–1279

    Article  PubMed  Google Scholar 

  8. Kamei K, Ito S, Nozu K, Fujinaga S, Nakayama M, Sako M, Saito M, Yoneko M, Iijima K (2009) Single dose of rituximab for refractory steroid-dependent nephrotic syndrome in children. Pediatr Nephrol 24:1321–1328

    Article  PubMed  Google Scholar 

  9. Fujinaga S, Kaneko K, Muto T, Ohtomo Y, Murakami H, Yamashiro Y (2006) Independent risk factors for chronic cyclosporine induced nephropathy in children with nephrotic syndrome. Arch Dis Child 91:666–670

    Article  CAS  PubMed  Google Scholar 

  10. Fujinaga S, Kaneko K, Takada M, Ohtomo Y, Akashi S, Yamashiro Y (2005) Preprandial C2 monitoring of cyclosporine treatment in children with nephrotic syndrome. Pediatr Nephrol 20:1359–1360

    Article  PubMed  Google Scholar 

  11. Fujinaga S, Ohtomo Y, Umino D, Takemoto M, Shimizu T, Yamashiro Y, Kaneko K (2007) A prospective study on the use of mycophenolate mofetil in children with cyclosporine-dependent nephrotic syndrome. Pediatr Nephrol 22:71–76

    Article  PubMed  Google Scholar 

  12. Komiya H, Masubuchi Y, Mori Y, Tajima N (2008) The validity of body mass index criteria in obese school-age children. Tohoku J Exp Med 214:27–37

    Article  PubMed  Google Scholar 

  13. Shalhoub RJ (1974) Pathogenesis of lipoid nephrosis: a disorder of T-cell function. Lancet 2:556–560

    Article  CAS  PubMed  Google Scholar 

  14. Grimbert P, Audard V, Remy P, Lang P, Sahali D (2003) Recent approaches to the pathogenesis of minimal-change nephrotic syndrome. Nephrol Dial Transplant 18:245–248

    Article  CAS  PubMed  Google Scholar 

  15. Kemper MJ, Meyer-Jark T, Lilova M, Müller-Wiefel DE (2003) Combined T- and B-cell activation in childhood steroid-sensitive nephrotic syndrome. Clin Nephrol 60:242–247

    CAS  PubMed  Google Scholar 

  16. Haffner D, Fischer DC (2009) Nephrotic syndrome and rituximab: facts and perspectives. Pediatr Nephrol 24:1433–1438

    Article  PubMed  Google Scholar 

  17. François H, Daugas E, Bensman A, Ronco P (2007) Unexpected efficacy of rituximab in multirelapsing minimal change nephrotic syndrome in the adult: first case report and pathophysiological considerations. Am J Kidney Dis 49:158–161

    Article  PubMed  Google Scholar 

  18. Dötsch J, Müller-Wiefel DE, Kemper MJ (2008) Rituximab: is replacement of cyclophosphamide and calcineurin inhibitors in steroid-dependent nephrotic syndrome possible? Pediatr Nephrol 23:3–7

    Article  PubMed  Google Scholar 

  19. Sharma AP, Filler G (2009) Role of mycophenolate mofetil in remission maintenance after a successful response to rituximab. Pediatr Nephrol 24:423–424

    Article  PubMed  Google Scholar 

  20. Bagga A, Sinha A, Moudgil A (2007) Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med 356:2751–2752

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, Saitama Children′s Medical Center, 2100 Magome, Iwatsuki-ward, Saitama-city, Saitama, 339 8551, Japan

    Shuichiro Fujinaga, Daishi Hirano & Naoto Nishizaki

  2. Division of Nephrology, National Center for Child Health and Development, Tokyo, Japan

    Koichi Kamei & Shuichi Ito

  3. Department of Pediatrics, Juntendo Nerima Hospital, Tokyo, Japan

    Yoshiyuki Ohtomo

  4. Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan

    Toshiaki Shimizu

  5. Department of Pediatrics, Kansai Medical University, Osaka, Japan

    Kazunari Kaneko

Authors
  1. Shuichiro Fujinaga
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  2. Daishi Hirano
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  3. Naoto Nishizaki
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  4. Koichi Kamei
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  5. Shuichi Ito
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  6. Yoshiyuki Ohtomo
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  7. Toshiaki Shimizu
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  8. Kazunari Kaneko
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Correspondence to Shuichiro Fujinaga.

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Fujinaga, S., Hirano, D., Nishizaki, N. et al. Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine. Pediatr Nephrol 25, 539–544 (2010). https://doi.org/10.1007/s00467-009-1377-5

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  • DOI: https://doi.org/10.1007/s00467-009-1377-5

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