Rituximab in the treatment of nephrotic syndrome: a systematic review

Recently, the role of B cells in the pathogenesis of nephrotic syndrome is explained by some researchers. It has also been shown that the anti-CD20 antibody, rituximab, may be an option in the treatment of these patients. In this systematic review, we performed extensive search and identified studies on rituximab use in children with nephrotic syndrome. There are some case reports as well as larger series in this regard. The majority of these case reports and series have demonstrated the success of rituximab in the treatment of nephrotic syndrome, especially in pediatric patients with steroid-dependent and frequent-relapsing nephrotic syndrome. Nevertheless, the treatment strategies before and after rituximab infusion are not clear to date. On the other hand, it is believed that positive results on rituximab use in nephrotic syndrome are much more reported by researchers than the negative results and this is an important bias. Although most reports on rituximab use in pediatric patients have not recognized significant side effects, the long-term adverse events of rituximab are not known. Thus, controlled long-term studies are required to be done to assess the risk-benefit profile of rituximab in childhood nephrotic syndrome.