Relapse of membranous glomerulopathy after kidney transplantation: sustained remittance induced by rituximab

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Membranous glomerulopathy (MG) is a leading cause of nephrotic syndrome in adults.
• MG frequently recurs in kidney allografts despite standard immunosuppression.
• Recurrence poses a significant threat to long-term graft survival.

Observation:

• A 27-year-old male kidney transplant recipient developed nephrotic syndrome 11 months post-transplant.
• Allograft biopsy confirmed recurrent membranous glomerulopathy with significant lymphocyte infiltration.
• The patient presented with overt nephrotic syndrome and declining graft function.

Findings:

• Treatment with rituximab induced clinical remission of nephrotic syndrome.
• Remission was achieved before the third maintenance dose of rituximab.
• Sustained remission, indicated by low-level proteinuria, was maintained for 42 months post-treatment.

Implications:

• Rituximab may be an effective therapeutic option for relapsing membranous glomerulopathy in kidney transplant recipients.
• Targeting B-cells with rituximab could offer a novel strategy for managing antibody-mediated kidney diseases post-transplantation.
• This case highlights the potential for successful treatment of challenging allograft complications.