"Late" is the Most Prominent Feature and Risk Factor for Patients with Late-onset Lupus Nephritis
Hong Kong Journal of Nephrology
Rituximab is a chimeric murine /human monoclonal antibody which has emerged as a novel therapy for various glomerular diseases in Children. The optimal doses remain uncertain. We presented our experience by monitoring the B-lymphocyte (CD19+) subset count as a guide to adjust the dose of rituximab infusion. This indicator helps to avoid over-immunosuppression and to optimize the duration of B-lymphocyte (CD19+) depletion. Case Summaries: Patient 1: A 10-year-old boy had been diagnosed with
... diagnosed with steroiddependent nephrotic syndrome since 2 years of age and was resistant to cyclophosphamide therapy. His nephrotic syndrome remitted with cyclosporin A but with frequent relapses. Renal biopsy confirmed focal segmental glomerulosclerosis. He had serious complications of steroid and became tacrolimus dependent. Two doses of rituximab infusion (375 mg/m 2 ) were given weekly. Depletion of B-lymphocyte (CD19+) was achieved after the 2 nd dose of rituximab. His proteinuria improved and his steroid was weaned off 5 months after rituximab (Figure 1 ). Patient 2: A 16-year-old girl was diagnosed with systemic lupus erythematosus at 6 years of age. She had class III lupus nephritis diagnosed at 11 years old and was given a course of oral cyclophosphamide, followed by maintenance azathioprine and prednisolone. Mycophenolate mofetil and tacrolimus were added for recurrent relapses and uncontrolled disease. Two doses of rituximab infusion 500 mg (375 mg/m 2 ) were given weekly. She achieved better disease control with B-lymphocyte (CD19+) depletion which lasted for 4 months. Prednisolone was tapered to 7 mg daily. She experienced another relapse with nephrotic range proteinuria 9 months later. Another two doses of rituximab were given with good response. B-lymphocyte (CD19+) depletion lasted for another 10 weeks ( Figure 2 ) and her prednisolone was reduced to 5 mg daily.