Refractory Lupus Podocytopathy: The Role of Repeat Biopsy and Rituximab

Lupus podocytopathy is a rare renal manifestation of systemic lupus erythematosus (SLE) that requires treatment strategies distinct from those used for proliferative lupus nephritis. In this report, the author describes a 28-year-old man with biopsy-proven class III lupus nephritis whose proteinuria progressed despite multiple induction regimens, including high-dose corticosteroids with mycophenolate mofetil, voclosporin, and cyclophosphamide-based therapy. A repeat kidney biopsy revealed the development of lupus podocytopathy with features of the focal segmental glomerulosclerosis variant. On the basis of these findings, he was treated with a rituximab biosimilar, which led to improvements in both serologic activity and proteinuria. This case highlights the diagnostic utility of repeat kidney biopsy in refractory disease and supports the use of rituximab or its biosimilars as an effective therapeutic option for steroid-resistant lupus podocytopathy.