Safety and Efficacy of Rituximab in Children with Steroid-Dependent or Resistant Nephrotic Syndrome
Journal of Pediatric Nephrology,
Vol. 9 No. 2 (2021),
14 April 2021
,
Page 1-7
https://doi.org/10.22037/jpn.v8i2.33354
Abstract
Backgroundand Aim:Rituximab is a novel therapy that can help patients with steroid-dependent or resistant nephrotic syndrome.The aim of this study was to evaluate the efficacy of rituximab in children with corticosteroid-dependent and resistant nephrotic syndrome and to determine the factors associated with its efficacy. Methods:In this study, 40 children with corticosteroid-dependent or resistant nephrotic syndrome who were treated with rituximab in Dr. Sheikh Hospital,Mashhad,between 2014 and 2018 were enrolled. Patients with a history of hematuria, severe urinary tract infection, or secondary nephrotic syndrome were excluded. Results:The mean age of patients was 11.9 ± 5.04 years, and 55% were female. The most common underlying pathology of nephrotic syndrome was focal segmental glomerulonephritis (FSGS) (42.5%) followed by membranoproliferative glomerulonephritis (MPGN) and minimal change disease (MCD). Most of the participants (62.5%) were steroid-dependent and the rest (27.5%) were steroid resistant. Only 10% of the patients showed complications following rituximab administration and 57.5% went into complete remission. A negative family history and steroid-dependent nephrotic syndrome were significantly associated with a better treatment response. Moreover, patients with steroid-resistant nephrotic syndrome were more likely to have a positive family history, while factors associated with steroid response included underlying pathology, gender, and family history. Conclusion: Rituximab can cause remission in more than half of the patients with steroid-resistant or dependent nephrotic syndrome. Moreover, the only factors that reduce response to rituximab are a history of corticosteroid resistance and a positive family history of nephrotic syndrome.
Keywords:
- Nephrotic Syndrome
- Rituximab
- Corticosteroid Resistant
- FSGS
- MPGN
How to Cite
1.
Nourihosseini G, Gazanchian M, Ravanshad Y, Ravanshad S, Azarfar A, Esmaeeli M, et al. Safety and Efficacy of Rituximab in Children with Steroid-Dependent or Resistant Nephrotic Syndrome. J Ped Nephrol [Internet]. 2021 Mar. 31 [cited 2026 Jul. 8];9(2):1-7. Available from: https://journals.sbmu.ac.ir/jpn/article/view/33354
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[19] Kamei K, Ogura M, Sato M, Sako M, Iijima K, Ito S. Risk factors for relapse and long-term outcome in steroid-dependent nephrotic syndrome treated with rituximab. Pediatric Nephrology. 2016;31(1):89-95.
[20] Kamei K, Ito S, Nozu K, Fujinaga S, Nakayama M, Sako M, Saito M, Yoneko M, Iijima K. Single dose of rituximab for refractory steroid-dependent nephrotic syndrome in children. Pediatric nephrology. 2009;24(7):1321-8.
[21] Boyer O, Niaudet P. Nephrotic syndrome: Rituximab in childhood steroid-dependent nephrotic syndrome. Nature Reviews Nephrology. 2013;9(10):562.
[22] Haffner D, Fischer D-C. Nephrotic syndrome and rituximab: facts and perspectives. Pediatric Nephrology. 2009;24(8):1433-8.
[23] Hodson EM, Craig JC. Rituximab for childhood-onset nephrotic syndrome. The Lancet. 2014;384(9950):1242-3.
[24] Ravani P, Rossi R, Bonanni A, Quinn RR, Sica F, Bodria M, Pasini A, Montini G, Edefonti A, Belingheri M. Rituximab in children with steroid-dependent nephrotic syndrome: a multicenter, open-label, noninferiority, randomized controlled trial. Journal of the American Society of Nephrology. 2015;26(9):2259-66.
[2] Gipson DS, Massengill SF, Yao L, Nagaraj S, Smoyer WE, Mahan JD, Wigfall D, Miles P, Powell L, Lin J-J. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124(2):747-57.
[3] Hodson EM, Wong SC, Willis NS, Craig JC. Interventions for idiopathic steroid‐resistant nephrotic syndrome in children. Cochrane database of systematic reviews. 2016(10).
[4] Ishikura K, Ikeda M, Hattori S, Yoshikawa N, Sasaki S, Iijima K, Nakanishi K, Yata N, Honda M, Children JSgoRDi. Effective and safe treatment with cyclosporine in nephrotic children: a prospective, randomized multicenter trial. Kidney international. 2008;73(10):1167-73.
[5] Ishikura K, Yoshikawa N, Hattori S, Sasaki S, Iijima K, Nakanishi K, Matsuyama T, Yata N, Ando T, Honda M. Treatment with microemulsified cyclosporine in children with frequently relapsing nephrotic syndrome. Nephrology Dialysis Transplantation. 2010;25(12):3956-62.
[6] Hamasaki Y, Yoshikawa N, Hattori S, Sasaki S, Iijima K, Nakanishi K, Matsuyama T, Ishikura K, Yata N, Kaneko T. Cyclosporine and steroid therapy in children with steroid-resistant nephrotic syndrome. Pediatric nephrology. 2009;24(11):2177-85.
[7] Iijima K, Hamahira K, Tanaka R, Kobayashi A, Nozu K, Nakamura H, Yoshikawa N. Risk factors for cyclosporine-induced tubulointerstitial lesions in children with minimal change nephrotic syndrome. Kidney international. 2002;61(5):1801-5.
[8] Kamei K, Okada M, Sato M, Fujimaru T, Ogura M, Nakayama M, Kaito H, Iijima K, Ito S. Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome. Pediatric nephrology. 2014;29(7):1181-7.
[9] Iijima K, Sako M, Nozu K, Mori R, Tuchida N, Kamei K, Miura K, Aya K, Nakanishi K, Ohtomo Y. Rituximab for childhood-onset, complicated, frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome: a multicentre, double-blind, randomised, placebo-controlled trial. The Lancet. 2014;384(9950):1273-81.
[10] Sellier-Leclerc A-L, Macher M-A, Loirat C, Guérin V, Watier H, Peuchmaur M, Baudouin V, Deschênes G. Rituximab efficiency in children with steroid-dependent nephrotic syndrome. Pediatric Nephrology. 2010;25(6):1109-15.
[11] Kimata T, Hasui M, Kino J, Kitao T, Yamanouchi S, Tsuji S, Kaneko K. Novel use of rituximab for steroid-dependent nephrotic syndrome in children. American journal of nephrology. 2013;38(6):483-8.
[12] Azarfar A, Ravanshad Y, Mehrad-Majd H, Aval SB, Nastarani S, Emadzadeh M, Khazaei MR, Fazel M, Azimi B. Efficacy and Safety of rituximab in children with difficult-to-treat nephrotic syndrome; a systematic review. Journal of Renal Injury Prevention. 2018;7(4).
[13] Hoseini R, Sabzian K, Otukesh H, Zafaranloo N, Panahi P, Rahimzadeh N, Nakhaie S, Sepehi MA. Efficacy and safety of rituximab in children with steroid-and cyclosporine-resistant and steroid-and cyclosporine-dependent nephrotic syndrome. Iranian journal of kidney diseases. 2018;12(1):27.
[14] Lombel RM, Gipson DS, Hodson EM. Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO. Pediatric nephrology. 2013;28(3):415-26.
[15] Fujinaga S, Hirano D, Nishizaki N, Kamei K, Ito S, Ohtomo Y, Shimizu T, Kaneko K. Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine. Pediatric Nephrology. 2010;25(3):539-44.
[16] Guigonis V, Dallocchio A, Baudouin V, Dehennault M, Hachon-Le Camus C, Afanetti M, Groothoff J, Llanas B, Niaudet P, Nivet H. Rituximab treatment for severe steroid-or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases. Pediatric Nephrology. 2008;23(8):1269.
[17] Sinha A, Bhatia D, Gulati A, Rawat M, Dinda AK, Hari P, Bagga A. Efficacy and safety of rituximab in children with difficult-to-treat nephrotic syndrome. Nephrology Dialysis Transplantation. 2014;30(1):96-106.
[18] Ravani P, Magnasco A, Edefonti A, Murer L, Rossi R, Ghio L, Benetti E, Scozzola F, Pasini A, Dallera N. Short-term effects of rituximab in children with steroid-and calcineurin-dependent nephrotic syndrome: a randomized controlled trial. Clinical Journal of the American Society of Nephrology. 2011;6(6):1308-15.
[19] Kamei K, Ogura M, Sato M, Sako M, Iijima K, Ito S. Risk factors for relapse and long-term outcome in steroid-dependent nephrotic syndrome treated with rituximab. Pediatric Nephrology. 2016;31(1):89-95.
[20] Kamei K, Ito S, Nozu K, Fujinaga S, Nakayama M, Sako M, Saito M, Yoneko M, Iijima K. Single dose of rituximab for refractory steroid-dependent nephrotic syndrome in children. Pediatric nephrology. 2009;24(7):1321-8.
[21] Boyer O, Niaudet P. Nephrotic syndrome: Rituximab in childhood steroid-dependent nephrotic syndrome. Nature Reviews Nephrology. 2013;9(10):562.
[22] Haffner D, Fischer D-C. Nephrotic syndrome and rituximab: facts and perspectives. Pediatric Nephrology. 2009;24(8):1433-8.
[23] Hodson EM, Craig JC. Rituximab for childhood-onset nephrotic syndrome. The Lancet. 2014;384(9950):1242-3.
[24] Ravani P, Rossi R, Bonanni A, Quinn RR, Sica F, Bodria M, Pasini A, Montini G, Edefonti A, Belingheri M. Rituximab in children with steroid-dependent nephrotic syndrome: a multicenter, open-label, noninferiority, randomized controlled trial. Journal of the American Society of Nephrology. 2015;26(9):2259-66.
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