Abstract: FR-PO0718
Rituximab-Induced Hypogammaglobulinemia in Childhood Nephrotic Syndrome: Systematic Review and Meta Analysis
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Chung, Zinnia, McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
- Chung, Jason, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Yu, Andrew, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
Background
Rituximab, a chimeric anti-CD20 monoclonal antibody, is used as a steroid-sparing agent in complicated pediatric nephrotic syndrome. Hypogammaglobulinemia is a known side effect that can lead to severe infections and mortality, yet its incidence and risk factors remain unclear. This review aimed to determine the incidence of rituximab-induced hypogammaglobulinemia and related infections in children with nephrotic syndrome.
Methods
A systematic review of 5 databases from 1974-2024 was completed. Randomized and non-randomized studies with pediatric (<18 years) nephrotic syndrome patients receiving ≥1 rituximab dose were included. Hypogammaglobulinemia was defined by IgG levels >2 SD below the age-matched reference range.
Results
33 studies (n=3,495) were eligible for meta-analysis. The pooled incidence of hypogammaglobulinemia was 11.4% (95%CI: 6.4-19.5). Patients receiving rituximab had increased risk of hypogammaglobulinemia (RR: 1.81, 95%CI: 1.46-2.25). Meta-regression showed no significant effect of follow-up duration, age, sex, or cumulative dose. Of 517 hypogammaglobulinemia episodes, 93 (18%) infections occurred—4 fatal, 2 requiring ICU admission, 2 chronic, and 73 severe.
Conclusion
Hypogammaglobulinemia is a relatively common side effect of rituximab that can result in life threatening or chronic infections. The risk of hypogammaglobulinemia and infections should be weighed against the effectiveness of rituximab for nephrotic syndrome management.
Random effects meta-regression model for incidence of hypogammaglobinemia adjusting for follow-up, age, sex and cumulative dose of Rituximab
| Random effects, z-distribution | ||||||
| Point Estimate | Standard Error | 95% Lower bound | 95% Upper bound | Z-value | P-value | |
| Intercept | -4.91 | 4.553 | -13.82 | 4.02 | -1.077 | 0.281 |
| Follow-up | -0.02 | 0.162 | -0.34 | 0.30 | -0.130 | 0.896 |
| Age | 0.08 | 0.210 | -0.33 | 0.50 | 0.400 | 0.689 |
| Sex (% male) | 0.02 | 0.060 | -0.10 | 0.14 | 0.325 | 0.746 |
| Cumulative dose | 0.001 | 0.001 | -0.001 | 0.003 | 0.641 | 0.522 |