Abstract: TH-PO0851
Minimizing the Damage: Rituximab-Based Remission in Minimal Change Disease
Session Information
- Glomerular Case Reports: Potpourri
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Grigsby, Jennifer L., University of Nebraska Medical Center Department of Internal Medicine, Omaha, Nebraska, United States
- Foster, Kirk W., University of Nebraska Medical Center Department of Pathology Microbiology and Immunology, Omaha, Nebraska, United States
- Borghoff, Kathleen, University of Nebraska Medical Center Department of Internal Medicine, Omaha, Nebraska, United States
- Ravipati, Prasanth, University of Nebraska Medical Center Department of Internal Medicine, Omaha, Nebraska, United States
Introduction
Corticosteroids have been the cornerstone of first-line therapy for minimal change disease (MCD); however, they are associated with significant adverse effects, particularly in adult patients who are more likely to have comorbid conditions. Rituximab (RTX) has gained traction in pediatric nephrology for children with relapsing disease, but experience and data for its use as induction immunosuppression in adults is limited. We present a case wherein RTX was utilized for induction to limit steroid exposure in an adult with prior severe steroid toxicity, highlighting a potential steroid sparing strategy in the management of adult MCD.
Case Description
A 49-year-old male presented with anasarca, acute kidney injury, and 14 g of proteinuria with a history of sarcoidosis affecting the lungs and testicles. His renal function precipitously worsened during evaluation, with serum creatinine reaching 4.3 mg/dL, prompting empiric glucocorticoid therapy with 60 mg/day of Prednisone. He disclosed a history of steroid-induced epidural lipomatosis, warranting judicious steroid use. Kidney biopsy demonstrated diffuse foot process effacement with mild (< 5%) IFTA and no evidence for renal sarcoidosis, consistent with MCD. Given previously described utilization of RTX in steroid-dependent nephrotic syndrome, and need to limit steroid duration and intensity, a RTX based regimen was initiated. He received 2 doses of 1 g of RTX and his prednisone was tapered quickly over 4 weeks. Thirty days after the first dose of RTX, he was no longer on prednisone, and his renal function had normalized with complete resolution of proteinuria. Peripheral B-cell depletion was confirmed. He received two additional doses of maintenance RTX therapy every 6 months after induction. At 1018 days after initial RTX dosing, he remains in complete remission.
Discussion
Though Rituximab has a role for relapsing and steroid-dependent MCD, its use as a potential induction agent is an area of interest. The data available is largely in patients without acute renal failure at the time of administration and follow-up is limited. Our case highlights the utility of RTX as a means of avoiding prolonged steroid use in a patient with acute renal failure secondary to MCD and a history of significant steroid toxicity, with sustained complete remission observed over three years of follow-up.