Abstract: TH-PO964
Remission of Refractory THSD7A-Associated Membranous Nephropathy Using Rituximab: A Case Report
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Ningning, Hu, Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai, China
- Lin, Fujun, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai, China
Introduction
Rituximab (RTX) is reported to induce clinical remission in 60-80% of primary membranous nephropathy (MN) patients. Due to the rarity, only four thrombospondin type-1 domain-containing 7A (THSD7A) associated cases were included in clinical trials of RTX treating MN, without detailed description of clinical information or treatment outcome. Here, we reported the successful RTX treatment of a THSD7A-associated MN patient non-responsive to tacrolimus and glucocorticoids.
Case Description
A 72-year-old male was admitted to Xinhua Hospital because of persistent nephrotic-range proteinuria and non-responsive to tacrolimus and glucocorticoids. Laboratory results included 24hr proteinuria 6.2g, serum albumin 2.15g/dL and serum creatinine 1.39mg/dL. Renal biopsy results suggested MN with negative glomerular staining of phospholipase A2 receptor and IgG4 but positive THSD7A by immunohistochemistry. Serum THSD7A-antibody titer was 1:100 by indirect immunofluorescence. The patient had radical rectectomy 7 years ago without metastasis. Rectal cancer tissue was reviewed and weakly positive THSD7A staining was found, which can be seen in 43% of rectal tumors. Intensive screening ruled out cancer recurrence or metastasis and RTX was given at weekly dose of 375mg/m2 for four weeks. At month 6, the patient achieved partial proteinuria remission and THSD7A-antibody titer decreased to 1:10.
Discussion
In this refractory case, the treatment of RTX achieved partial remission of proteinuria and circulating THSD7A antibody depletion at month 6, supporting its good efficacy on THSD7A-associated MN. We also emphasize that screening for malignancy is warranted in THSD7A-associated MN before immunosuppressive therapy.
Fig.2 Histological findings.
Fig.2 A summary of the clinical course.