Rituximab therapy for primary glomerulonephritis: Report on two cases

Area of Science:

• Nephrology
• Immunology
• Rheumatology

Background:

• Primary glomerulonephritis is a significant cause of kidney failure.
• Limited evidence exists on rituximab's efficacy and safety in primary glomerulonephritis.
• Standard treatments like corticosteroids and cyclophosphamide offer variable benefits.

Observation:

• Two male patients with rapidly progressive glomerulonephritis were treated.
• Both patients had previously received corticosteroids and cyclophosphamide with minimal improvement.
• One patient with mixed cryoglobulinemia showed improved kidney function after rituximab, while the other did not.

Findings:

• Rituximab demonstrated potential benefit in one patient with mixed cryoglobulinemia, leading to dialysis independence.
• No renal improvement was observed in the second patient treated with rituximab.
• Both patients developed sepsis post-treatment, and one patient died two months after rituximab therapy.

Implications:

• Rituximab's use in primary glomerulonephritis warrants caution, especially in patients with renal impairment.
• Severe infections are a significant risk associated with rituximab therapy in this context.
• Further research is needed to clarify rituximab's role and optimize its use in treating primary glomerulonephritis.