engleski

RITUXIMAB THERAPY FOR MEMBRANOUS NEPHROPATHY: A CASE REPORT

Membranous nephropathy (MN) remains a leading cause of nephrotic syndrome in adults. In most patients, an underlying etiology for the lesion is unknown and the disorder is termed idiopathic (IMN). IMN patients exhibit circulating antibodies of IgG4 subtype against a conformation-dependent epitope in the M-type phospholipase A2 receptor (PLA2R). Rituximab, a monoclonal antibody to the CD20 antigen of B cells, offers a new approach to treating IMN that may potentially address the pathogenesis of the disease and offer interference with greater selectivity in targets. There are no RCTs using rituximab for initial therapy of IMN, although large observational studies have provided encouraging data. We report a case of IMN that was treated with rituximab. A 56-year-old man initialy presented two years prior with edema, nephrotic-range proteinuria and an eGFR level of 35 ml/min/1, 73m2. A kidney biopsy was perfomed and he had been diagnosed with stage II/III membranous nephropathy. The presence of PLA2R autoantibody in the serum was also detected. The patient was initially treated with angiotensin receptor blocker, however nephrotic-range proteinuria persisted at approximately 11-15 g/dU. Cyclosporine 350 mg/day and prednisolone 15 mg/day were then administered for 6 months, with no response. The patient was admitted for rituximab treatment. Urea and creatinine levels were 5, 3 mmol/L and 175 umol/L, respectively. Proteinuria was 11 g/dU. Rituximab 1 g was administered on Day 1 and Day 15. Telmisartan 80 mg/day was continued irrespective of treatment. One month after the initiation of rituximab treatment, the patient's proteinuria decreased to 6, 8 g/dU. As illustrated in our case, rituximab therapy could be a feasible treatment option with minimal side effects for IMN patients who are refractory to immunosuppressive therapy. Compared with recent studies, our follow-up period is relatively short, and a longer follow-up period would be desirable.

RITUXIMAB THERAPY ; MEMBRANOUS NEPHROPATHY

nije evidentirano