Articles, Issue 1/2022

The Role of Rituximab in the Management of Childhood Nephrotic Syndrome

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I. Ivanova, G. Zlatanova, S. Yankova, G. Mihneva, M. Gaydarova


Abstract

Idiopathic nephrotic syndrome is the most common glomerulopathy in childhood. In over 20% of children the disease occurs with frequent recurrences or with pronounced corticosteroid dependence. Between 1 and 3% of the children with INS are resistant to steroids and all immunosuppressive drugs. In these cases Rituximab is used as the second line therapy. Rituximab is a chimeric mouse/human monoclonal antibody
against the CD20 antigen on the surface of B-lymphocytes. It was originally developed to treat patients with B-cell non-Hodgkin‘s lymphoma, and now is used for many autoimmune diseases such as granulomatous polyangiitis, microscopic polyangiitis, rheumatoid arthritis and others. In 2004, Benz and colleagues reported the use of Rituximab in a child with steroid-dependent nephrotic syndrome and
thrombotic thrombocytopenic purpura, observing remission. There are many scientific reports of the use of Rituximab in children with nephrotic syndrome. They use different dose and different intervals between infusions of the drug. The research for new options for the treatment of nephrotic syndrome in pediatric patients is a challenge for pediatric nephrologists. The purpose of this review is to present the knowledge
gained so far about the efficacy and safety of Rituximab in various types of nephrotic syndrome, as well as possible side effects.
Key words: Rituximab, nephrotic syndrome, childhood

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Address for correspondence:

Department of Nephrology and dialysis of
University Children`s Hospital
11, “Acad. Iv. Geshov”, Blvd.
1606, Sofia
Bulgaria
e-mail: ivelina.ivanova.md@gmail.com