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Kidney Week

Abstract: SA-PO912

Analysis of the Efficacy and Influencing Factors of Rituximab in the Treatment of Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Cheng, Jiawei, Xiangya Hospital Central South University, Changsha, Hunan, China
  • Peng, Zhangzhe, Xiangya Hospital Central South University, Changsha, Hunan, China
Background

Membrane nephropathy (MN) is the most common primary glomerular disease that causes adult nephrotic syndrome in the world. Primary membranous nephropathy (pMN) can progress to end-stage renal disease. Rituximab (RTX) has been listed as the first-line treatment for patients with medium and high risk pMN.

Methods

This study retrospectively analyzed 83 patients with pMN in XX Hospital who were confirmed by renal biopsy and received RTX treatment. According to the clinical outcome, the patients were divided into complete remission (CR), partial remission (PR) and no response (NR). CR, PR were considered effective in treatment while NR was considered ineffective in treatment. The baseline values of patients with different clinical outcomes were compared to explore the influencing factors that affect the efficacy of RTX in the treatment of pMN patients.

Results

After a follow-up of 10.66 (7.25, 16.46) months, 65.1% of those pMN patients achieved clinical remission, of which 27.7% had complete remission and 37.3% had partial remission. Patients with effective treatment (CR, PR) showed a significant decrease in urinary protein creatinine ratio after RTX treatment, while creatinine and eGFR remained stable. Patients with ineffective treatment (NR) showed no decrease in urinary protein creatinine ratio after RTX treatment, while creatinine significantly increased and eGFR significantly decreased. During follow-up, 9 patients (10.8%) experienced infection related adverse reactions. Multivariate Cox regression analysis showed that the combined use of glucocorticoids (p=0.027, HR=2.05), serum albumin (p=0.006, HR=1.10), and urinary light chain LAMBDA/KAPPA ratio (>0.622)(p=0.011, HR=0.33) were independent influencing factors on the effectiveness of RTX in treating pMN. Patients with lower serum albumin and higher urinary LAMBDA/KAPPA ratio may be more likely to have ineffective treatment, and the combined use of glucocorticoids may promote RTX induced disease remission.

Conclusion

RTX has a good therapeutic effect on pMN, which can reduce urinary protein and increase albumin in patients, maintain the stability of blood creatinine and eGFR, and have a low incidence of adverse reactions. The combined use of glucocorticoids, serum albumin and urinary LAMBDA/KAPPA ratio are independent factors affecting the effectiveness of RTX in the treatment of pMN.

Funding

  • Clinical Revenue Support