Der Nephrologe

, Volume 8, Issue 2, pp 144–149 | Cite as

Rituximab bei primärer FSGS und MCD im Erwachsenenalter

Leitthema

Zusammenfassung

Steroidabhängiges und steroidresistentes nephrotisches Syndrom bleiben eine therapeutische Herausforderung, da Steroide und die alternativ/additiv verwendeten Immunsuppressiva ein sehr ungünstiges Nebenwirkungsprofil aufweisen. Rituximab (RTX) konnte bei Kindern mit steroidabhängigem nephrotischen Syndrom bei primärer fokal-segmentaler Glomerulosklerose (pFSGS) und Minimal-Change-Disease (MCD) bereits erfolgreich eingesetzt werden. Bei erwachsenen Patienten mit pFSGS oder MCD gibt es einzelne Fallberichte und Fallserien, welche keine einheitlichen Ergebnisse zeigen, denenzufolge aber Patienten mit steroidabhängigem nephrotischen Syndrom und vor allem Patienten mit MCD am meisten von einer RTX-Therapie profitieren dürften. Um die Wertigkeit der Therapie zu sichern, sind aber weitere kontrollierte und randomisierte Studien notwendig, die insbesondere RTX mit der Standardtherapie vergleichen.

Schlüsselwörter

Rituximab Nephrotisches Syndrom Primäre fokal-segmentale Glomerulosklerose Minimal-Change-Disease 

Rituximab for adult primary FSGS and MCD

Abstract

Steroid-resistant and steroid-dependent nephrotic syndromes remain a therapeutic challenge as long-term steroid use and alternatively/additionally used immunosuppressive agents exhibit an extremely unfavorable spectrum of adverse events. Rituximab (RTX) has emerged as an efficacious therapy for childhood steroid-dependent nephrotic syndrome due to primary focal segmental glomerulosclerosis (pFSGS) and minimal change disease (MCD). In adult patients with pFSGS and MCD single case reports and case series have shown variable therapeutic response rates after RTX therapy. In general, patients with steroid-dependent nephrotic syndrome and in particular patients with MCD have shown an impressive clinical improvement after RTX therapy. To evaluate the efficacy of RTX randomized controlled trials in a prospective manner would be highly desirable.

Keywords

Rituximab Nephrotic syndrome Focal segmental glomerulosclerosis Minimal change disease 

Literatur

  1. 1.
    Braun N, Schmutzler F, Lange C et al (2008) Immunosuppressive treatment for focal segmental glomerulosclerosis in adults. Cochrane Database Syst Rev (3):CD003233Google Scholar
  2. 2.
    Choi MJ, Eustace JA, Gimenez LF et al (2002) Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 61:1098–1114PubMedCrossRefGoogle Scholar
  3. 3.
    Chun MJ, Korbet SM, Schwartz MM et al (2004) Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants. J Am Soc Nephrol 15:2169–2177PubMedCrossRefGoogle Scholar
  4. 4.
    Cravedi P, Ruggenenti P, Sghirlanzoni MC et al (2007) Titrating rituximab to circulating B cells to optimize lymphocytolytic therapy in idiopathic membranous nephropathy. Clin J Am Soc Nephrol 2:932–937PubMedCrossRefGoogle Scholar
  5. 5.
    Datta SK (2009) Anti-CD20 antibody is an efficient therapeutic tool for the selective removal of autoreactive T cells. Nat Clin Pract Rheumatol 5:80–82PubMedCrossRefGoogle Scholar
  6. 6.
    Eguchi A, Takei T, Yoshida T et al (2010) Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome. Nephrol Dial Transplant 25:124–129PubMedCrossRefGoogle Scholar
  7. 7.
    El-Reshaid K, Sallam HT, Hakim AA et al (2012) Rituximab in treatment of idiopathic glomerulopathy. Saudi J Kidney Dis Transpl 23:973–978PubMedCrossRefGoogle Scholar
  8. 8.
    Fernandez-Fresnedo G, Segarra A, Gonzalez E et al (2009) Rituximab treatment of adult patients with steroid-resistant focal segmental glomerulosclerosis. Clin J Am Soc Nephrol 4:1317–1323PubMedCrossRefGoogle Scholar
  9. 9.
    Fernandez-Nebro A, Fuente JL de la, Carreno L et al (2012) Multicenter longitudinal study of B-lymphocyte depletion in refractory systemic lupus erythematosus: the LESIMAB study. Lupus 21:1063–1076PubMedCrossRefGoogle Scholar
  10. 10.
    Filler G (2003) Treatment of nephrotic syndrome in children and controlled trials. Nephrol Dial Transplant 18(Suppl 6):vi75–vi78PubMedCrossRefGoogle Scholar
  11. 11.
    Fornoni A, Sageshima J, Wei C et al (2011) Rituximab targets podocytes in recurrent focal segmental glomerulosclerosis. Sci Transl Med 3:85ra46PubMedCrossRefGoogle Scholar
  12. 12.
    Gipson DS, Trachtman H, Kaskel FJ et al (2011) Clinical trial of focal segmental glomerulosclerosis in children and young adults. Kidney Int 80:868–878PubMedCrossRefGoogle Scholar
  13. 13.
    Hoxha E, Stahl RA, Harendza S (2011) Rituximab in adult patients with immunosuppressive-dependent minimal change disease. Clin Nephrol 76:151–158PubMedGoogle Scholar
  14. 14.
    Jones RB, Tervaert JW, Hauser T et al (2010) Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med 363:211–220PubMedCrossRefGoogle Scholar
  15. 15.
    Kemper MJ, Gellermann J, Habbig S et al (2012) Long-term follow-up after rituximab for steroid-dependent idiopathic nephrotic syndrome. Nephrol Dial Transplant 27:1910–1915PubMedCrossRefGoogle Scholar
  16. 16.
    Kong WY, Swaminathan R, Irish A (2012) Our experience with rituximab therapy for adult-onset primary glomerulonephritis and review of literature. Int Urol Nephrol [Epub ahead of print]Google Scholar
  17. 17.
    Magnasco A, Ravani P, Edefonti A et al (2012) Rituximab in children with resistant idiopathic nephrotic syndrome. J Am Soc Nephrol 23:1117–1124PubMedCrossRefGoogle Scholar
  18. 18.
    Moghadam-Kia S, Werth VP (2010) Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol 49:239–248PubMedCrossRefGoogle Scholar
  19. 19.
    Ochi A, Takei T, Nakayama K et al (2012) Rituximab treatment for adult patients with focal segmental glomerulosclerosis. Intern Med 51:759–762PubMedCrossRefGoogle Scholar
  20. 20.
    Palmer SC, Nand K, Strippoli GF (2008) Interventions for minimal change disease in adults with nephrotic syndrome. Cochrane Database Syst Rev (1):CD001537Google Scholar
  21. 21.
    Ravani P, Magnasco A, Edefonti A et al (2011) Short-term effects of rituximab in children with steroid- and calcineurin-dependent nephrotic syndrome: a randomized controlled trial. Clin J Am Soc Nephrol 6:1308–1315PubMedCrossRefGoogle Scholar
  22. 22.
    Ruggenenti P, Cravedi P, Chianca A et al (2012) Rituximab in idiopathic membranous nephropathy. J Am Soc Nephrol 23:1416–1425PubMedCrossRefGoogle Scholar
  23. 23.
    Sellier-Leclerc AL, Baudouin V, Kwon T et al (2012) Rituximab in steroid-dependent idiopathic nephrotic syndrome in childhood – follow-up after CD19 recovery. Nephrol Dial Transplant 27:1083–1089PubMedCrossRefGoogle Scholar
  24. 24.
    Stone JH, Merkel PA, Spiera R et al (2010) Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 363:221–232PubMedCrossRefGoogle Scholar
  25. 25.
    Sugiura H, Takei T, Itabashi M et al (2011) Effect of single-dose rituximab on primary glomerular diseases. Nephron Clin Pract 117:c98–c105PubMedCrossRefGoogle Scholar
  26. 26.
    Waldman M, Crew RJ, Valeri A et al (2007) Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol 2:445–453PubMedCrossRefGoogle Scholar
  27. 27.
    Weidenbusch M, Rommele C, Schrottle A et al (2012) Beyond the LUNAR trial. Efficacy of rituximab in refractory lupus nephritis. Nephrol Dial Transplant 28:106–111PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Universitätsklinik für Innere Medizin IV (Nephrologie und Hypertensiologie)Medizinische Universität InnsbruckInnsbruckÖsterreich

Personalised recommendations