Abstract: TH-PO222

A Case of Low-Dose Rituximab for the Treatment of Steroid Resistant Nephrotic Syndrome

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Murata, Marie, St.Marianna medical school of medicine, Kawasaki, Japan
  • Ichikawa, Daisuke, St Marianna University of Medical School, Yokohama City, Kanagawa, Japan
  • Suzuki, Tomo, Kidney and Vascular Pathology, Faculty of Medicine ,University of Tsukuba, Tsukuba, Japan
  • Watanabe, Shiika, the Kawasaki Municipal Tama Hospital, Kawasaki Citiy Tama Ward, Japan
  • Hisamichi, Mikako, St.Marianna university school of medicine, Kawasaki, Japan
  • Shibagaki, Yugo, Division of Nephrology and Hypertension, St Marianna University Hospital, Kawasaki, Japan
Background

The efficacy of rituximab for frequent relapsing nephrotic syndrome has been reported. Some reports have a use of low dose rituximab for treatment of the ABO incompatible kidney transplant patients. Rituximab dosage of 100 mg/body was administered, which led to immediate depletion of CD20-positive cells. Therefore, a low dose rituximab may have a possibility of same effect compared to the normal dose rituximab.

Methods

A 22-year-old Japanese man presented with severe peripheral edema within several days after onset. His past history is not in particular. Nephrotic syndrome was diagnosed and minimal change disease was diagnosed by renal biopsy. Methyl-prednisolone was administered at 500mg/day for 3 days and prednisolone was administered at 1mg/kg/day. Nephrotic syndrome become a remission at 7 days, however nephrotic syndrome was replaced at 28 days. After that methyl-prednisolone was administered at 500mg/day for 3 days two times and cyclosporine was added however, nephrotic syndrome was not improved. An initial rituximab dosage of 100 mg/body was administered. Two weeks later, urinary protein was 1g or less. Rituximab dosage of 100 mg/body was administered. Two months later, it became possible to taper prednisolone by 5mg. Six months later, it became possible to taper off prednisolone. He maintains remission of nephrotic syndrome by administering of rituximab dosage of 100 mg/body every four months.

Conclusion

Low dose rituximab might be an option for the treatment of steroid-resistant nephrotic syndrome. It was expected a reduction of the cost-effectiveness and side effect of rituximab. This case could be steroid dependent nephrotic syndrome from this history, therefore low dose rituximab might be an option for maintenance of steroid dependent nephrotic syndrome.