Rituximab in the treatment of primary glomerulopathies – our experience

Authors: Karol Graňák 1;  Matej Vnučák 1;  Margaréta Pytliaková 2;  Udovít Laca 1;  Marián Mokáň 3;  Ivana Dedinská 1
Authors‘ workplace: Chirurgická klinika a Transplantačné centrum, Univerzitná nemocnica Martin a Jesseniova lekárska fakulta, Univerzity Komenského 1;  Klinika anesteziológie a intenzívnej medicíny, Univerzitná nemocnica Martin a Jesseniova lekárska fakulta, Univerzity Komenského 2;  I. interná klinika, Univerzitná nemocnica Martin a Jesseniova lekárska fakulta Univerzity Komenského 3
Published in: Vnitř Lék 2021; 67(E-3): 3-7
Category: Original Contributions


Introduction: Since 2012, when The Kidney Disease: Improving Global Outcomes (KDIGO) initiative published the first recommendations for the management and treatment of glomerular diseases, there has been enormous progress in understanding pathogenesis, identifying new diagnostic biomarkers and treating these diseases. Rituximab had become a promisisng treatment option in patients with primary glomerular disease, as confirmed by several clinical studies, where it has led to a significant reduction in proteinuria and a reduction in the incidence of relapses of the underlying disease. In this work we present our experiences with rituximab treatment.

Materials and methods: We retrospectively analyzed 9 patients with primary glomerulopathy resistant to srandard immunosuppressive therapy who received rituximab as rescue treatment. We evaluated the effect of rituximab induction treatment on the development of quantitative proteinuria.

Results: By evaluating the 24-hour proteinuria before and after treatment, we demonstrated a statistically significant decrease in proteinuria in our group of patients immediately after the las dose of rituximab. We did not notice a significant change in renal function.

Conclusion: Rituximab represents an effective alternative in the treatment of primary glomerulopathies, especially in cases of resistance to standard immunosuppressive therapy, which is shared by the clinical experience presented by us.


primary glomerulopathy – Proteinuria – rituximab


1. Floege J, Barbour SJ, Cattran DC et al. Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019; 95(2): 268–280.

2. Rojas-Rivera JE, Carriazo S, Ortiz A. Treatment of idiopathic membranous nephropathy in adults: KDIGO 2012, cyclophosphamide and cyclosporine A are out, rituximab is the new normal. Clin Kidney J. 2019; 12(5): 629–638.

3. Fervenza FC, Appel GB, Barbour SJ et al. Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy. N Engl J Med. 2019; 381(1): 36–46.

4. Troyanov S, Wall CA, Miller JA et al. Idiopathic membranous nephropathy: definition and relevance of a partial remission. Kidney Int 2004; 66: 1199–1205.

5. Beck LH jr, Bonegio RG, Lambeau G et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med 2009; 361: 11–21.

6. Tomas NM, Beck LH jr, Meyer-Schwesinger C et al. Trombospondin type-1 domain- containing 7A in idiopathic membranous nephropathy. N Eng J Med 2014; 371: 2277–2287.

7. Kidney Disease: Improving Global Outcome (KDIGO) Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl 2012; 2: 139–274.

8. Alfaadhel T, Cattran D. Management of membranous nephropathy in Western countries. Kidney Dis (Basel) 2015; 1: 126–137.

9. Rudnicki M. Rituximab for Treatment of Membranoproliferative Glomerulonephritis and C3 Glomerulopathies. Biomed Res Int. 2017; 2017: 2180508.

10. Beaudreuil S, Lorenzo HK, Elias M et al. Optimal management of primary focal segmental glomerulosclerosis in adults. Int J Nephrol Renovasc Dis. 2017; 10: 97–107.

11. Uffing A, Pérez-Sáez MJ, Mazzali M et al. Recurrence of FSGS after Kidney Transplantation in Adults. Clin J Am Soc Nephrol. 2020; 15(2): 247–256.

12. Němec P. Rituximab (MabThera®) – nový biologický lék v terapii revmatoidní artritidy. Vnitr Lek 2007; 53(11): 1199–1210.

13. Dahan K, Debiec H, Plaisier E et al. Rituximab for Severe Membranous Nephropathy: A 6-Month Trial with Extended Follow-Up. J Am Soc Nephrol. 2017; 28(1): 348–358.

14. Rojas-Rivera J, Fernández-Juárez G, Ortiz A et al. A European multicentre and open- -label controlled randomized trial to evaluate the efficacy of Sequential treatment with TAcrolimus-Rituximab versus steroids plus cyclophosphamide in patients with primary Membranous Nephropathy: the STARMEN study. Clin Kidney J 2015; 8: 503–510.

15. Scolari F. Rituximab versus steroids and cyclophosphamide in the treatment of idiopathic membranous nephropathy (RI-CYCLO) https://clinicaltrials.gov/ct2/show/ NCT03018535 (6 August 2019, date last accessed).

16. Tsagalis G, Psimenou E, Nakopoulou L et al. Combination treatment with plasmapheresis and rituximab for recurrent focal segmental glomerulosclerosis after renal transplantation. Artif Organs. 2011; 35(4): 420–425.

17. Cho JH, Lee JH, Park GY et al. Successful treatment of recurrent focal segmental glomerulosclerosis with a low dose rituximab in a kidney transplant recipient. Ren Fail. 2014; 36(4): 623–626.

18. Goswami RP, Sircar G, Sit H et al. Cyclophosphamide versus mycophenolate versus rituximab in lupus nephritis remission induction. JCR: Journal of Clinical Rheumatology. J Clin Rheumatol. 2019; 25(1): 28–35.

19. Stone JH, Merkel PA, Spiera R et al. Rituximab versus cyclophosphamide for ANCA- -Associated vasculitis. N Engl J Med. 2010; 363(3): 221–232.

Diabetology Endocrinology Internal medicine
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