Repeated Administrations of Rituximab along with Steroids and Immunosuppressive Agents in Refractory
Shuichiro Fujinaga1, Koji Sakuraya
1Division of Nephrology, Saitama Childrens Medical Center and *Department of Pediatrics, Juntendo University School of Medicine; Japan. Correspondence to: Dr Shuichiro Fujinaga, Division of Nephrology, Saitama Childrens Medical Center, 2100 Magome, Iwatsuki-ku, Saitama-city Saitama 339 8551, Japan. f_shuich@d2.dion.ne.jp.
Background:
A recent randomized control trial in children with steroid-resistant nephrotic syndrome revealed that two doses of rituximab did not reduce proteinuria.
Case Characteristics:
A 14-month-old boy developed refractory steroid-resistant nephrotic syndrome due to focal segmental glomerulosclerosis.
Observation:
The patient achieved complete remission 11 months after disease onset following eight doses of rituximab combined with steroids and cyclosporine.
Message:
Long-lasting B cell depletion with repeated rituximab administrations may be required to achieve complete remission in patients with steroid-resistant nephrotic syndrome and massive proteinuria.
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