Efficacy of Rituximab Therapy in Children with Nephrotic Syndrome: a 10-year Experience from an Iranian Pediatric Hospital

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2022 Jan 13

PMID 35022016

Authors

Behnaz Bazargani

Zahra Noparast

Leila Khedmat

Daryoosh Fahimi

Seyed Taher Esfahani

Mastaneh Moghtaderi

Arash Abbasi

Azadeh Afshin

Sayed Yousef Mojtahedi

Affiliations

Soon will be listed here.

Abstract

Background: There are controversy results in the optimal management of children with steroid-dependent and steroid-resistant nephrotic syndrome (SDNS, SRNS). This study aimed to determine the efficacy and safety of rituximab (RTX) in these pediatric patients.

Methods: Medical records of 1-18-year-old Iranian children with SDNS (n = 26) and SRNS (n = 22) with a follow-up for at least 24 months were included from 2009 to 2019. The short- and long-term responses to RTX were respectively evaluated to determine the random protein-to-creatinine ratio after 6 and 24 months and classified as complete (CR) and partial (PR) remission or no response.

Results: Male patients (n = 26) were slightly predominate. The median age of patients at the time of RTX therapy was 8.6 ± 4.01 years. At the end of the 6-month follow-up, CR and PR occurred in 23 (47.9%) and 12 (25%) patients, respectively. Of 23 patients with CR, 18 (69.2%) and 5(22.7%) had SDNS and SRNS, respectively (p < 0.005). However, only 18 (37.5%) of patients after 24 months had been in CR. No significant difference in the CR rate was found between the two groups. RTX was more effective when administered during the proteinuria-free period (p = 0.001).

Conclusion: In the short term, RTX significantly was efficient in inducing complete or PR in SDNS and SRNS patients. However, the favorable response rate in a long-term follow-up was insignificantly lower between the two groups.

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References

Gulati A, Sinha A, Jordan S, Hari P, Dinda A, Sharma S . Efficacy and safety of treatment with rituximab for difficult steroid-resistant and -dependent nephrotic syndrome: multicentric report. Clin J Am Soc Nephrol. 2010; 5(12):2207-12. PMC: 2994081. DOI: 10.2215/CJN.03470410. View

Kang H, Cheong H . Nephrotic syndrome: what's new, what's hot?. Korean J Pediatr. 2015; 58(8):275-82. PMC: 4573440. DOI: 10.3345/kjp.2015.58.8.275. View

Harita Y . Application of next-generation sequencing technology to diagnosis and treatment of focal segmental glomerulosclerosis. Clin Exp Nephrol. 2017; 22(3):491-500. PMC: 5956018. DOI: 10.1007/s10157-017-1449-y. View

McKinney P, Feltbower R, Brocklebank J, Fitzpatrick M . Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire, UK. Pediatr Nephrol. 2002; 16(12):1040-4. DOI: 10.1007/s004670100021. View

Hamasaki Y, Yoshikawa N, Hattori S, Sasaki S, Iijima K, Nakanishi K . Cyclosporine and steroid therapy in children with steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2009; 24(11):2177-85. DOI: 10.1007/s00467-009-1264-0. View

Otukesh H, Hoseini R, Rahimzadeh N, Fazel M . Rituximab in the treatment of nephrotic syndrome: a systematic review. Iran J Kidney Dis. 2013; 7(4):249-56. View

Zhao Z, Liao G, Li Y, Zhou S, Zou H . The efficacy and safety of rituximab in treating childhood refractory nephrotic syndrome: a meta-analysis. Sci Rep. 2015; 5:8219. PMC: 4314653. DOI: 10.1038/srep08219. View

. Chapter 3: Steroid-sensitive nephrotic syndrome in children. Kidney Int Suppl (2011). 2014; 2(2):163-171. PMC: 4089737. DOI: 10.1038/kisup.2012.16. View

Magnasco A, Ravani P, Edefonti A, Murer L, Ghio L, Belingheri M . Rituximab in children with resistant idiopathic nephrotic syndrome. J Am Soc Nephrol. 2012; 23(6):1117-24. PMC: 3358759. DOI: 10.1681/ASN.2011080775. View

10.

Fornoni A, Sageshima J, Wei C, Merscher-Gomez S, Aguillon-Prada R, Jauregui A . Rituximab targets podocytes in recurrent focal segmental glomerulosclerosis. Sci Transl Med. 2011; 3(85):85ra46. PMC: 3719858. DOI: 10.1126/scitranslmed.3002231. View

11.

Maratea D, Bettio M, Corti M, Montini G, Venturini F . The efficacy and safety of rituximab in treating childhood nephrotic syndrome: an Italian perspective. Ital J Pediatr. 2016; 42(1):63. PMC: 4943005. DOI: 10.1186/s13052-016-0271-6. View

12.

Kamei K, Okada M, Sato M, Fujimaru T, Ogura M, Nakayama M . Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2014; 29(7):1181-7. DOI: 10.1007/s00467-014-2765-z. View

13.

Guigonis V, Dallocchio A, Baudouin V, Dehennault M, Hachon-LE Camus C, Afanetti M . Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases. Pediatr Nephrol. 2008; 23(8):1269-79. DOI: 10.1007/s00467-008-0814-1. View

14.

Sharples P, Poulton J, White R . Steroid responsive nephrotic syndrome is more common in Asians. Arch Dis Child. 1985; 60(11):1014-7. PMC: 1777619. DOI: 10.1136/adc.60.11.1014. View

15.

Le Berre L, Bruneau S, Naulet J, Renaudin K, Buzelin F, Usal C . Induction of T regulatory cells attenuates idiopathic nephrotic syndrome. J Am Soc Nephrol. 2008; 20(1):57-67. PMC: 2615726. DOI: 10.1681/ASN.2007111244. View

16.

Eddy A, Symons J . Nephrotic syndrome in childhood. Lancet. 2003; 362(9384):629-39. DOI: 10.1016/S0140-6736(03)14184-0. View

17.

Trautmann A, Bodria M, Ozaltin F, Gheisari A, Melk A, Azocar M . Spectrum of steroid-resistant and congenital nephrotic syndrome in children: the PodoNet registry cohort. Clin J Am Soc Nephrol. 2015; 10(4):592-600. PMC: 4386250. DOI: 10.2215/CJN.06260614. View

18.

Sellier-Leclerc A, Belli E, Guerin V, Dorfmuller P, Deschenes G . Fulminant viral myocarditis after rituximab therapy in pediatric nephrotic syndrome. Pediatr Nephrol. 2013; 28(9):1875-9. DOI: 10.1007/s00467-013-2485-9. View

19.

Ito S, Kamei K, Ogura M, Udagawa T, Fujinaga S, Saito M . Survey of rituximab treatment for childhood-onset refractory nephrotic syndrome. Pediatr Nephrol. 2012; 28(2):257-64. DOI: 10.1007/s00467-012-2319-1. View

20.

Kemper M, Gellermann J, Habbig S, Krmar R, Dittrich K, Jungraithmayr T . Long-term follow-up after rituximab for steroid-dependent idiopathic nephrotic syndrome. Nephrol Dial Transplant. 2011; 27(5):1910-5. DOI: 10.1093/ndt/gfr548. View