Published: 2020-12-23

A case report on usage of rituximab on complicated steroid-dependent nephrotic syndrome

Shravan Jayachandran, S. Suwitha, A. Priya, K. Arun Chander


Nephrotic syndrome (NS) is one of the common yet challenging childhood disease. Treating NS with immunosuppressants like corticosteroids is typically effective. However, there are significant evidences which displayed resistance patterns to the former drugs. Here in this case, a male patient came to the nephrology department with the history of steroid dependant nephrotic syndrome with complaint of its infrequent relapse. The condition was complicated since, the patient was on multiple steroids even after which there were recurrent episodes of syndrome. Considering the status, Mycophenolate mofetil was added as a supportive treatment for the management of the disease along with steroids, still the outcome was unremarkable. Hence, rituximab was ordered (four cycles). The outcome this time was appreciable, rituximab administration produced a positive result. No events were recorded during the treatment duration.



Nephrotic syndrome, Immunosuppressants, Relapse, Resistant patterns

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Iijima K, Sako M, Kamei K, Nozu K. Rituximab in steroid-sensitive nephrotic syndrome: lessons from clinical trials. Pediatr Nephrol. 2018;33:1449-455.

Koumi ME. Rituximab in steroid-dependent nephrotic syndrome. Iran J Kidney Dis. 2013;6(7):502-06.

Kallash M, Smoyer WE, Mahan JD. Rituximab Use in the Management of Childhood Nephrotic Syndrome. Front Pediat.r 2019;178(7):1-10.

Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362:629-39.

Cattran DC, Feehally J, Cook HT, Liu ZH, Fervenza FC, Mezzano SA et al. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group: KDIGO Clinical practice guideline for glomerulonephritis. Kidney Int. 2012;2:139-274.

Kalra S, Kanitkar M, Tiewsoh K. Use of levamisole in children with nephrotic syndrome: A retrospective study to examine its adverse effects in children with nephrotic syndrome. J Mar Med Soc. 2017;19(2):87-90

Benz K, Dötsch J, Rascher W, Stachel D. Change of the course of steroid-dependent nephrotic syndrome after rituximab therapy. Pediatr Nephrol. 2004;19:794-7.

Gilbert RD, Hulse E, Rigden S. Rituximab therapy for steroid-dependent minimal change nephrotic syndrome. Pediatr Nephrol. 2006;21:1698-1700.

François H, Daugas E, Bensman A, Ronco P. Unexpected efficacy of rituximab in multirelapsing minimal change nephrotic syndrome in the adult: first case report and pathophysiological considerations. Am J Kidney Dis. 2007;49:158-61.

Kimata T, Hasui M, Kino J, Kitao T, Yamanouchi S, Tsuji S et al. Novel Use of Rituximab for Steroid-Dependent Nephrotic Syndrome in Children. Am J Nephrol. 2013;38:483-8.

Hofstra JM, Deegens JKJ, Wetzels JFM. Rituximab: effective treatment for severe steroid dependent minimal change nephrotic syndrome? Nephrol Dial Transplant. 2007;22:2100-2.

Iorember F, Aviles D, Kallash M, Bamgbola O. Cost analysis on the use of rituximab and calcineurin inhibitors in children and adolescents with steroid-dependent nephrotic syndrome. Pediatric Nephrol. 2018;33:261-7.

Takura T, Takei T, Nitta K. Cost-effectiveness of administering rituximab for steroid-dependent nephrotic syndrome and frequently relapsing nephrotic syndrome: a preliminary study in japan. Sci Rep. 2017;7:46036.

Takura T, Takei T, Nitta K. Socioeconomics of Administering Rituximab for Nephrotic Syndrome. Contrib Nephrol. 2018;195:110-9.

Delbet JD, Leclerc G, Ulinski T. Idiopathic nephrotic syndrome and rituximab: may we predict circulating B lymphocytes recovery?. Pediatr Nephrol. 2018;34:529-32.