Kidney Week

Abstract: FR-PO0816

Rituximab Response Patterns: Podocytopathies Compared with Membranous Nephropathy

Session Information

• Glomerular Diseases: Practice and New Concepts Shaping Modern Care
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Moura, Ana Laura Pereira, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, SP, Brazil

Ana Laura Pereira Moura

• Lucena, Julia Mello, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, SP, Brazil

Julia Mello Lucena, MS

• Pontes, Barbhara Thaís Maciel, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, SP, Brazil

Barbhara Thaís Maciel Pontes, MD

• Braga Barbosa, Gessica Sabrine, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, SP, Brazil

Gessica Sabrine Braga Barbosa, MD

• Dantas, Marcio, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, SP, Brazil

Marcio Dantas, MD, PhD

Background

Rituximab (RTX) has been increasingly used to treat glomerulopathies. The KDIGO guidelines advocate RTX as first-line therapy to primary membranous nephropathy (MN) and recommend as alternative treatment to steroid-dependent or frequently relapsing primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). We compared the therapeutic response to RTX between FSGS/MCD and MN.

Methods

A retrospective unicentric study was conducted to analyze clinical and laboratory features of individuals with primary FSGS/MCD and MN after RTX therapy. The study period was defined as T0 (time of RTX infusion), 6, and 12 months post-RTX prescription.

Results

A total of 51 individuals received RTX between 2021-2025, 25 with FSGS/MCD and 26 with MN. The mean age in FSGS/MCD group was lower (32 ±13 vs 50 ±12 y-old). Steroid dependence was the primary indication for RTX in the FSGS/MCD group (41%). PLA2R-associated MN accounted for 65.3%. The most common regimen of RTX was the two 1 g infusions given 2 weeks apart, without repeated doses before 12m in most cases. MN group had higher levels of proteinuria at T0 and the proteinuria persisted in nephrotic range after 6m, while it reached < 1g/day in FSGS/MCD; after 12m, no difference between proteinuria levels was found; albumin levels showed a similar pattern (Table 1). Although FSGS/MCD presented with higher eGFR (ml/min/1.73m²), it was not relevant (85 vs 57, p=0.1 and 98 vs 62, p=0.22, at T0 and after 12m, respectively). After 6m, 42% of individuals with FSGS/MCD achieved complete remission, compared to only 8% of those with MN (p=0.013). After 12m, the proportion of complete remission was 53% and 38%, for FSGS/MCD and MN (p=0.5). Anti-PLA2R levels became negative in 60% of cases.

Conclusion

The reduction in proteinuria following RTX infusion appears to be more rapid in FSGS/MCD with major proportion of complete remission than in MN after 6m, although no difference between proteinuria levels and complete remission was detected after 1 year. The initial differences in response between diseases help clinicians predict the timing of therapeutic effects of RTX.