Rituximab therapy for primary glomerulonephritis: Report on two cases

Abstract

The evidence in the medical literature on the efficacy and safety of rituximab therapy for primary glomerulonephritis is limited and controversial. We describe two male Caucasian patients with rapidly progressive kidney failure due to primary proliferative glomerulonephritis. Both of them received high-dose intravenous corticosteroids and oral cyclophosphamide with limited benefit. The first patient (hepatitis C virus-negative mixed cryoglobulinemia) underwent plasma-exchange with intravenous immunoglobulins; he showed significant benefit on kidney function (he became dialysis independent with serum creatinine going back to 1.6 mg/dL) after one rituximab pulse even if urinary abnormalities were still present. No improvement in renal function or urinary changes occurred in the second patient. Both these individuals developed sepsis over the follow-up, the first patient died two months after rituximab therapy. This report is in keeping with the occurrence of severe infections after rituximab therapy in patients with renal impairment at baseline and concomitant high-dose steroids.

Keywords: Chronic kidney disease; Cryoglobulinemic vasculitis; Membranoproliferative glomerulonephritis; Rituximab

Core tip: A small but growing body of evidence is emerging on the efficacy and safety of rituximab therapy for primary glomerulonephritis. Various authors have claimed that rituximab for glomerular diseases is effective and has minimal adverse effects. We report on two male Caucasian patients who were refractory to conventional immunosuppressive therapy; each of them received one rituximab pulse and developed sepsis over the follow-up, the first patient died two months after rituximab therapy. The risks (and the predictive factors) of severe infections in kidney patients on rituximab therapy are unclear and appear an area of active research.