Rituximab in a desensitization protocol as a rescue therapy in severe nephrotic syndrome-a case report
Agata Bukoska1, Aleksandra Rymarz1, Filip Wantoch-Rekowski1
1Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Journal of Nephrology
|April 1, 2026
Summary
Minimal change disease (MCD) in children often requires treatment beyond steroids. Rituximab (RTX) desensitization offers a safe alternative for patients experiencing hypersensitivity reactions, enabling remission and steroid withdrawal.
Area of Science:
- Nephrology
- Immunology
- Pediatric Medicine
Background:
- Idiopathic nephrotic syndrome (NS) is a common childhood kidney disease, with minimal change disease (MCD) being the most frequent histological type.
- Glucocorticosteroids are the primary treatment, but frequent relapses and steroid dependence can cause complications.
- Rituximab (RTX) is an alternative for refractory cases, reducing relapses and medication reliance by depleting B cells.
Purpose of the Study:
- To describe a case of multidrug-resistant MCD in a young adult.
- To evaluate the efficacy and safety of a Rituximab (RTX) desensitization protocol in a patient with a hypersensitivity reaction to RTX.
- To assess the potential for achieving remission and steroid discontinuation using RTX desensitization.
Main Methods:
- A 19-year-old male with frequently relapsing, steroid-dependent, multidrug-resistant NS due to MCD was treated.
- The patient developed a hypersensitivity reaction to RTX, precluding standard infusion.
- A 12-step RTX desensitization protocol was implemented to allow continued RTX administration.
Main Results:
- The RTX desensitization protocol was successfully completed.
- Subsequent RTX doses were safely administered.
- The patient achieved remission of nephrotic syndrome.
- Glucocorticosteroid therapy was gradually discontinued.
Conclusions:
- Rituximab (RTX) desensitization is a viable strategy for patients with nephrotic syndrome who develop hypersensitivity reactions to RTX.
- This approach can enable successful treatment, remission, and steroid-sparing in refractory cases.
- RTX desensitization expands therapeutic options for complex cases of minimal change disease (MCD).
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