Complete Remission With Rituximab in Relapsed Primary Focal Segmental Glomerulosclerosis Without Use of High-Dose...

Focal segmental glomerulosclerosis (FSGS) is a histopathological lesion characterised clinically by nephrotic range proteinuria and frequently progresses to end-stage kidney disease. Primary FSGS is a complex disease process hypothesised to result from circulating permeability factors resulting in podocyte injury. Glucocorticoids remain the cornerstone of immunosuppressive treatment in the disease; however there is emerging evidence that FSGS may be autoantibody-mediated, and patients may benefit from targeted B-cell depleting therapies, such as rituximab. There is minimal evidence evaluating rituximab as an alternative to high-dose glucocorticoids to achieve remission. Given that relapses and steroid dependence are common in primary FSGS necessitating exposure to long-term glucocorticoids, steroid-sparing therapies are needed to reduce glucocorticoid adverse effects. We present the case of a female in her 20s with relapsed primary FSGS with a history of steroid-induced hypomania. Prior to her relapse she was on maintenance tacrolimus and subsequently achieved rapid clinical and biochemical improvement with the addition of rituximab and low-dose prednisolone.