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      Takahito Moriyama

      Department of Medicine, Kidney Center

      Tokyo Women’s Medical University

      8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666 (Japan)

      E-Mail [email protected]

      Nitta K (ed): Recent Advances in the Pathogenesis and Treatment of Kidney Diseases. Contrib Nephrol. Basel, Karger, 2018, vol 195, pp 12–19 (DOI: 10.1159/000486930)

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Rituximab as a Therapeutic Option for Steroid-Sensitive Minimal Change Nephrotic Syndrome in Adults

      Yuko Iwabuchi · Takahito Moriyama · Mitsuyo Itabashi · Takashi Takei · Kosaku Nitta

      Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan

      ______________________

      Abstract

      Minimal change nephrotic syndrome (MCNS) usually responds to steroids but frequently relapses, requiring additional treatment with immunosuppressive agents. Rituximab is a chimeric murine/human monoclonal immunoglobulin G1 antibody that targets CD20, a B-cell differentiation marker. B-cell recovery begins at approximately 6 months following the completion of treatment. Rituximab has a beneficial effect, with the sustained remission or reduction of proteinuria in patients with steroid-dependent MCNS. Relapses are thought to be associated with an increase in CD19 cells. The mean serum half-life of rituximab was reported to be 10–15 days in patients with steroid-dependent MCNS. Only infusion reactions, such as rash and chills, occurred after single-dose rituximab infusion and can be managed by pre-medication or infusion rate adjustments. Even though severe adverse effects of rituximab are not expected, we must be aware of potentially life-threatening adverse effects. Controlled randomized trials that include adult patients with steroid-dependent MCNS are required to prove the efficacy and safety of rituximab and to evaluate the cost-effectiveness of rituximab treatment. In this review, we highlight recent studies and discuss the effects of these studies on the management of patients with MCNS in adults.

      © 2018 S. Karger AG, Basel

Minimal change nephrotic syndrome (MCNS) accounts for 12.6% of all cases of primary adult nephrotic syndrome in Japan [1]. MCNS usually responds to glucocorticoids (steroids), and the long-term prognosis is generally good.