Anti-CD20 monoclonal antibody (rituximab) for the treatment of recurrent idiopathic membranous nephropathy in a renal transplant patient

Am J Transplant. 2006 Dec;6(12):3017-21. doi: 10.1111/j.1600-6143.2006.01544.x.

Abstract

Idiopathic membranous nephropathy (IMN) remains the most common histologic entity associated with adult-onset nephrotic syndrome. The therapy for IMN is challenging. Steroids and various other immunosuppressive agents have been tried in IMN; however, current agents have not altered the course of IMN, are nonspecific and can be very toxic. In native kidneys affected by IMN, rituximab, a monoclonal antibody against the B-cell surface antigen CD20, has been shown to reduce proteinuria and prevent disease progression. In this report, we describe a 39-year-old white male with end-stage renal disease secondary to IMN that, 4 months post living unrelated kidney transplant, developed recurrent IMN with 18 g/day of proteinuria. In addition to angiotensin converting enzyme inhibitor and statins, the patient was treated with 4 weekly doses of 375 mg/m2 of rituximab with significant reduction in proteinuria, a corresponding increase in serum albumin and improvement in hypercholesterolemia. At 3 years post-transplant, his kidney function remains stable with 0.5 g/day of proteinuria.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Glomerular Filtration Rate
  • Glomerulonephritis, Membranous / drug therapy*
  • Humans
  • Immunologic Factors / therapeutic use*
  • Kidney Transplantation / immunology*
  • Male
  • Postoperative Complications / drug therapy
  • Proteinuria
  • Recurrence
  • Rituximab
  • Serum Albumin / analysis

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Immunologic Factors
  • Serum Albumin
  • Rituximab