RITUXIMAB IN THE TREATMENT OF REFRACTORY IDIOPATHIC MEMBRANOUS NEPHROPATHY IN PAKISTANI POPULATION
Abstract
This is the time of paradigm shift in the treatment of primary membranous nephropathy which carries a major position in causing nephrotic syndrome in adult population and has been labelled as a cause of idiopathic primary glomerulonephropathy in about 90% of patients. It is two folds more common in male population as compared to female population.It is held responsible for about 0.7% cases of end stage kidney disease. However, unfortunately, the optimal treatment for idiopathic membranous nephropathy is still unresolved. Rituximab has been made specially to attach to CD20 receptors and therefore cause depletion of B cells.It has been found to be a potential treatment option for idiopathic membranous nephropathy. We present four cases of primary idiopathic membranous nephropathy that were successfully treated with rituximab. They were all previously treated with conservative management followed by immunosuppression therapies but none of them was fortunate enough to achieve partial or complete remission. Therefore, all of them were given two doses of rituximab (375 mg/m2), two weeks apart. Except for only one of the patients who required a second round of rituximab therapy, they all achieved complete remission of the disease without any significant side effects of the drug. This represents that those patients of idiopathic membranous nephropathy who are refractory cases with use of steroids, calcineurin inhibitors, (cyclosporine or tacrolimus) or alkylating agents (cyclophosphamide or chlorambucil) still have a hope in the form of Rituximab which has no doubt shown promising results in Pakistani population. Indeed, Rituximab may also be used early in the course of the disease to improve the outcome of the disease.Keywords: primary idiopathic membranous nephropathy; Proteinuria; Rituximab; Cyclophosphamide; Cyclosporine; Tacrolimus; Corticosteroids; nephrotic syndromeReferences
Cattran D. Management of membranous nephropathy: when and what for treatment. J Am Soc Nephrol 2005;16(5):1188-94.
Ruggenenti P, Chiurchiu C, Brusegan V, Abbate M, Perna A, Filippi C, et al. Rituximab in idiopathic membranous nephropathy: a one-year prospective study. J Am Soc Nephrol 2003;14(7):1851-7.
Fervenza FC, Cosio FG, Erickson SB, Specks U, Herzenberg AM, Dillon JJ, et al. Rituximab treatment of idiopathic membranous nephropathy. Kidney Int 2008;73(1):117-25.
Fervenza FC, Abraham RS, Erickson SB, Irazabal MV, Eirin A, Specks U, et al. Rituximab therapy in idiopathic membranous nephropathy: a 2-year study. Clin J Am Soc Nephrol 2010;5(12):2188-98.
Quaglia M, Stratta P. Idiopathic membranous nephropathy: management strategies. Drugs 2009;69(10):1303-17.
Jayne D. Role of rituximab therapy in glomerulonephritis. J Am Soc Nephrol 2010;21(1):14-7.
Austin HA 3rd, Antonovych TT, MacKay K, Boumpas DT, Balow JE. NIH conference. Membranous nephropathy. Ann Intern Med 1992;116(8):672-82.
McDonald V, Leandro M. Rituximab in non-haematological disorders of adults and its mode of action. Br J Haematol 2009;146(3):233-46.
Polanco N, Gutiérrez E, Covarsà A, Ariza F, Carreno A, Vigil A, et al. Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. J Am Soc Nephrol 2010;21(4):697-704.
Hofstra JM, Fervenza FC, Wetzels JF. Treatment of idiopathic membranous nephropathy. Nat Revi Nephrol 2013;9(8):443-58.
Faurschou M, Sorensen IJ, Mellemkjaer L, Loft AG, Thomsen BS, Tvede N, et al. Malignancies in Wegener's granulomatosis: incidence and relation to cyclophosphamide therapy in a cohort of 293 patients. J Rheumatol 2008;35(1):100-5.
Beck LH Jr, Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. New Engl J Med 2009;361(1):11-21.
Tomas NM, Beck LH Jr, Meyer-Schwesinger C, Seitz-polski B, Ma H, Zahner G, et al. Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy. New Engl J Med 2014;371(24):2277-87.
Beck LH Jr, Fervenza FC, Beck DM, Bonegio RG, Malik FA, Erickson SB, et al. Rituximab-induced depletion of anti-PLA2R autoantibodies predicts response in membranous nephropathy. J Am Soc Nephrol 2011;22(8):1543-50.
Remuzzi G, Chiurchiu C, Abbate M, Brusegan V, Bontempelli M, Ruggenenti P. Rituximab for idiopathic membranous nephropathy. Lancet 2002;360(9337):923-4.
Ruggenenti P, Cravedi P, Chianca A, Perna A, Ruggiero B, Gaspari F, et al. Rituximab in idiopathic membranous nephropathy. J Am Soc Nephrol 2012;23(8):1416-25.
Segarra A, Praga M, Ramos N, Polanco N, Cargoll, Gutierrez-Solis E, et al. Successful treatment of membranous glomerulonephritis with rituximab in calcineurin inhibitor-dependent patients. Clin J Am Soc Nephrol 2009;4(6):1083-8.
Dahan K, Debiec H, Plaisier E, Cachanado M, Rousseau A, Wakselman L, et al. Rituximab for severe membranous nephropathy: a 6-month trial with extended follow-up. J Am Soc Nephrol 2017;28(1):348-58.
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