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Kidney Week

Abstract: SA-PO721

Treatment of Membranous Nephropathy With Crescent Nephritis by Rituximab With Corticosteroids

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Zhang, Fan, Hunan Provincial People's Hospital, Changsha, China
  • Yang, Yiya, Hunan Provincial People's Hospital, Changsha, China
  • Chen, Yinyin, Hunan Provincial People's Hospital, Changsha, China
  • Liang, Yumei, Hunan Provincial People's Hospital, Changsha, China
  • Luo, Xun, Hunan Provincial People's Hospital, Changsha, China
Introduction

Crescent formation is rare in primary membranous nephropathy (MN).Previously reported cases of MN and crescent formation without any signs of vasculitis, lupus, or anti-GBM disease showed unfavorable therapeutic response and tended to have worse renal outcomes. Here, we presented a rare case presented with NS and kidney biopsy-proven MN.

Case Description

A 71-year-old female was admitted to hospital with nausea,vomiting and hypourocrinia for 20 days.Serum creatinine was 539umol/l.Urinary sediment showed 120000 red blood cells per ml,4+ protein.Serum albumin was 24.99 g/L.Anti-PLA2R antibodies were positive of 415.29(<14) RU/mL.ANCA,anti-GBM antibody,anti-PR3 antibody,ANA antibody were all negative.
Kidney biopsy (Fig. 1) contained 11 glomeruli,1 of them were globalsclerosis,6 of them had crescent formation.GBM thickening and “spike and dome”appearance observed.Immunofluorescence showed granular deposits of IgG++, C3+and IgM+ along capillary loop.The diagnosis was stage II MN combined with crescentic glomerulonephritis.She was treated with methylprednisolone 500mg per day for 3 days then reduced to 40mg per day, in combination with rituximab 600mg per week for 4 weeks(total dose 2.4mg),combined with intermittent hemodialysis(Figure 2). One month later,her serum creatinine was 139(40–100)umol/L. Urinary sediment showed no red blood cells ,2+ protein. Glucocorticoids were gradually reduced and the patient got complete remission 3 months later.Anti-PLA2R antibody became negative.

Discussion

Now there is no guideline for the treatments to MN with crescents and previously reported cases showed poor response of the therapy. Our case suggests a beneficial effect of rituximab for MN patients with crescentic glomerulonephritis. It provides that there is a pathologic feature of MN and crescents in the absence of known immunologic factors and rituximab could serves as an effective cure and could be considered in serious conditions of MN.

Kidney biopsy examinations.