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Nefrologia clinica

RITUXIMAB AND GLOMERULONEPHRITIS: A CASE SERIES

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Abstract

Background. Rituximab, a monoclonal antibody directed against the CD20 molecule found on pre-B cells and mature B cells. CD20 mediates B-cell proliferation and differentiation. Then, rituximab may represent a therapeutic option for antibody-mediated kidney diseases. We report a single centre experience on the efficacy and safety of rituximab in 23 patients affected by different glomerular diseases.

Patients and Methods. Twenty-three patients with nephrotic syndrome and histological diagnosis of glomerular disease were treated with rituximab (375 mg/m2 once a week, for four consecutive weeks), as a rescue therapy, from 2007 to 2010. The minimum follow-up was 12 months. Before, 6 and 12 months after treatment, we evaluated renal function, daily proteinuria and circulating CD20+ lymphocytes.

Results. and Conclusion. In the membranous nephropathy group (n. 7) we obtained a complete remission of the nephrotic syndrome in 4 cases, a partial remission in 2 cases and no effect in 1 case. In the 5 patients with focal segmental glomerulosclerosis we observed no effect on proteinuria in 4 cases and a partial remission in a single case. In the two cases with mixed cryoglobulinemia secondary to HCV infection we obtained a partial remission of the proteinuria with a stable renal function. In the lupus nephritis group (n. 6) we observed a total remission in 5 cases and 1 partial remission. In the patient with membrano-priliferative glomerulonephritis we observed a slight improvement of renal function and a reduction of proteinuria. CD20+ lymphocytes were significantly reduced 12 months after therapy (before 11.20+3.50%; after 5.45+1.50%). Rituximab was very well tolerated and no adverse events were reported. In conclusion, our results suggest that rituximab is safe and well tolerated and it is particularly effective in glomerular disease characterized by the activation of the humoral immune response.

F. Bruno(1), B. Infante(1), G. Stallone(1), L. Tartaglia(1), G. Grandaliano(1), L. Gesualdo(2)
((1)Sc Di Nefrologia, Dialisi E Trapianto, Dipartimento Di Scienze Mediche E Chirurgiche, Università Di Foggia , (2)Sc Di Nefrologia, Dialisi E Trapianto, Dipartimento Emergenza E Trapianti Di Organo, Università Di Bari )
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Realizzazione: Tesi S.p.A.

Per assistenza contattare: Claudia Ingrassia, Tesi S.p.A.
0172 476301 — claudia.ingrassia@gruppotesi.com