DOI 10.5414/CN107299

Clinical Nephrology, Volume 77 (2012) - April (290 - 295)

Rituximab therapy for Type I membranoproliferative glomerulonephritis

John J. Dillon1, Michelle Hladunewich2, William E. Haley3, Heather N. Reich2, Daniel C. Cattran2, Fernando C. Fervenza1
1 Division of Nephrology, Hypertension, Mayo Clinic, Rochester, MN, USA, 2 Toronto Glomerulonephritis Registry, University of Toronto, Toronto, Ontario, Canada, 3 Division of Nephrology, Hypertension, Mayo Clinic, Jacksonville, FL, USA

Abstract

Aims: Type I membranoproliferative glomerulonephritis (MPGN) is an immune-complex disease with a relatively poor prognosis. It has no established treatment in adults. Our hypothesis was that this disease would respond to B cell depletion with rituximab, an anti-CD20 monoclonal antibody. Methods: We conducted an openlabel trial, in Canada and the United States, of rituximab in 6 adult patients with Type I MPGN (4 idiopathic, 2 with cryoglobulinemia). The rituximab dose was 1,000 mg intravenously on Day 1 and on Day 15. The patients were followed for 1 year. The primary outcome was the change in proteinuria. Results: Peripheral blood B cells were suppressed, after rituximab, in all patients. The mean urinary protein excretion was 3.9 ± 2.0 g/d before treatment. Proteinuria fell in all patients, at all-time points, after rituximab administration. The difference was statistically significant (p < 0.05) at 6, 9 and 12 months, but not at 3 months. The minimum mean urinary protein excretion was 1.4 ± 1.4 g/d at 9 months. There were 2 complete and 3 partial remissions among the 6 patients. The creatinine clearance did not change significantly over the course of the study. There were no adverse effects. Conclusions: Rituximab reduced proteinuria among patients with Type I MPGN. This trial suggests that B cells may play a role in this disease and that additional study of B-cell suppression is warranted.

Author Details

Authors

  • John J. Dillon1
  • Michelle Hladunewich2
  • William E. Haley3
  • Heather N. Reich2
  • Daniel C. Cattran2
  • Fernando C. Fervenza1

Departments

  • 1 Division of Nephrology, Hypertension, Mayo Clinic, Rochester, MN, USA,
  • 2 Toronto Glomerulonephritis Registry, University of Toronto, Toronto, Ontario, Canada,
  • 3 Division of Nephrology, Hypertension, Mayo Clinic, Jacksonville, FL, USA

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