Investigating the relationship between rituximab use and the severity of proteinuria improvement in steroid-dependent and recurrent nephrotic syndrome

Abstract

In recent years, studies from various countries have demonstrated that Rituximab, a monoclonal antibody against B lymphocytes with the CD-20 antigen, is effective in treating steroid-resistant nephrotic syndrome (SRNS) and steroid-dependent nephrotic syndrome (SDNS). More recent studies provide stronger evidence supporting the benefits of Rituximab in frequent relapsing nephrotic syndrome (FRNS) or SDNS. However, comparing the results of these scattered studies can be challenging due to variations in Rituximab dosages, the number of doses administered, and the timing of these doses. Furthermore, similar studies have been very few and limited in our country. Therefore, this study aimed to evaluate the effect of Rituximab on proteinuria improvement in children with steroid-dependent and frequently relapsing nephrotic syndrome. Methods: In this study, the medical records of children (aged 1 to 18 years) hospitalized in Tabriz Children's Hospital from the beginning of 2019 to the end of 2023, who were diagnosed with steroid-dependent or frequently relapsing nephrotic syndrome based on clinical findings and paraclinical data, and who received Rituximab in addition to standard treatments, were selected. According to standard protocols, these patients were followed up for one year after receiving Rituximab. Clinical findings and paraclinical data, including instances of nephrotic syndrome relapse (recurrence of proteinuria) and related factors such as the average dose of prednisolone administered, frequency of nephrotic syndrome relapses, and possible complications, were collected from patient records and telephone follow-ups and used for statistical analysis. Results: Edema (11 patients) and hemorrhage were the most common systemic symptoms observed. The average hospital stay for participants was 6.57 ± 1.75 days. One patient required dialysis, and blood transfusion was recorded in the clinical files of two patients, both of whom received whole blood. None of the patients required surgery. The final outcomes showed complete recovery in 16 patients, with two patients recovering but experiencing persistent complications.