Rituximab in the Treatment of Thymoma-Related Minimal Change Disease
- Glomerular Diseases: Case Reports
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Trials
- Nie, Yuxin, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
Thymoma may cause autoimmune-related kidney disease. This article presents two cases of thymoma-related kidney disease treated with oral prednisone in combination with rituximab. Remission of proteinuria were achieved, and shrinkage of the thymoma mass was observed on the CT scan.
Case 1: A 67y male was admitted because of foamy urine and edema. Lab tests revealed hypoalbuminemia and proteinuria. Scr increased progressively, while auto-immune antibodies were negative. Chest CT showed a mass in the anterior mediastinum. The patient underwent a right posterior hepatic lobectomy in 2020.The pathology revealed a thymoma type B2. Other past history includes hypertension and diabetes. Based on the patient's clinical manifestations, history of thymoma, and renal biopsy, the patient was diagnosed as thymoma-related minimal change disease, acute interstitial inflammation, diabetic nephropathy, and hypertensive kidney injury. Methylprednisolone was administered 240mg/d *3d, followed by prednisone 30mg/d and rituximab 375mg/m2/week *4 weeks. Remission was achieved one month after completion of the RTX course. Surprisingly, the thymoma shrank on the CT scan.
Case 2: A 67y male was admitted because of foamy urine and edema. Lab tests showed a 24h urine protein of 8.78g. Plasma albumin was 16.9g/L, eGFR was 53mL/min/1.73 m2. The patient claimed a history of thymoma, and underwent thymectomy in 2014. PET-CT showed left pleural, left phrenic angle and cardiophrenic angle lymph node, and anterior chest wall subcutaneous metastases. The patient claim a history of hypertension. The final diagnosis based on clinical manifestations and renal biopsy was thymoma-related MCD, hypertensive kidney injury, and AIN. Steroid therapy (methylprednisolone 120mg/d*3d, followed by prednisone 40mg/d) combined with RTX (375mg/m2/week *4weeks) was administered. The patient’s proteinuria gradually decreased two months after RTX treatment, the urine protein was 0.67 g/24h at the latest follow-up. In addition, there was remission of the patient’s thymoma metastasis.
Experience in treating thymoma-related nephropathy with RTX is limited, our cases report the effectiveness of RTX in both MCD and thymoma. This report provide a new approach for treating thymoma-related kidney disease, especially for those who are not suitable for surgery.