Rituximab in treatment of anti-GBM antibody glomerulonephritis: A case report and literature review

Medicine (Baltimore). 2019 Nov;98(44):e17801. doi: 10.1097/MD.0000000000017801.


Rationale: Anti-glomerular basement membrane (GBM) disease is a T cell-mediated disease that has a poor prognosis with conventional therapy. We tested rituximab as a primary therapy to reduce anti-GBM antibody produced by B cells.

Patient concerns: A 53-year old woman with complaints of a fever, headache and abdominal discomfort showed renal failure with elevated anti-GBM antibody, and renal biopsy revealed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) 1 deposition along GBM.

Diagnoses: The patient's plasma contained autoantibodies against Goodpasture antigen, which is the NC domain of collagen IVα3, and CD4-positive helper T cells were found surrounding crescent glomeruli with the coexistence CD20-positive B cells.

Interventions: Rituximab with steroid and plasma exchange.

Outcomes: The levels of autoantibody for Goodpasture antigen were reduced, and the patient was able to temporarily withdraw from hemodialysis.

Lessons: B cell depletion with rituximab is effective as an initial therapy for anti-GBM disease.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anti-Glomerular Basement Membrane Disease / blood
  • Anti-Glomerular Basement Membrane Disease / drug therapy*
  • Anti-Glomerular Basement Membrane Disease / immunology
  • Autoantibodies / blood
  • Combined Modality Therapy
  • Female
  • Humans
  • Immunologic Factors / therapeutic use*
  • Middle Aged
  • Plasma Exchange / methods*
  • Rituximab / therapeutic use*
  • Steroids / therapeutic use*
  • Treatment Outcome


  • Autoantibodies
  • Immunologic Factors
  • Steroids
  • antiglomerular basement membrane antibody
  • Rituximab