Clinical practice guidelines for rituximab treatment in children with steroid-sensitive nephrotic syndrome

Steroid-sensitive nephrotic syndrome is a prevalent glomerular disease in children. The 2021 guidelines for glomerular disease management by Kidney Disease: Improving Global Outcomes and the 2023 recommendations for steroid-sensitive nephrotic syndrome management by International Pediatric Nephrology Association recommend rituximab for frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome in children. However, there is considerable variation in rituximab application, including administration timing, dose, frequency, concomitant medications, and follow-up schedules. In addition, rituximab use for nephrotic syndrome remains off-label in most countries.

The "Pediatric Nephrology Committee of the Chinese Medical Doctor Association", the "Pediatric Nephrology Society of the Chinese Medical Association", and the "Fudan University GRADE Center" collaborated to develop a clinical practice guideline for rituximab in pediatric steroid-sensitive nephrotic syndrome. Databases and starting/ending time for retrieval were as follows. Databases in English: PubMed, Embase, Cochrane, and Scopus; database in Chinese: Chinese Biomedical Literature Service provided by SinoMed. The publication dates were limited to those from 2004 to June 26, 2022.

Through systematic reviews and meta-analyses covering nine clinically relevant patient or population covered, intervention, comparator, and outcome questions, seven recommendations were formulated and formally graded according to these guidelines.

This guideline aspires to serve as a pivotal resource for healthcare providers, offering guidance on administration timing, dosage, frequency, concomitant medications, and follow-up protocols.