Department of Pediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada, N6A 5W9.
Pediatr Nephrol. 2011 Oct;26(10):1759-62. doi: 10.1007/s00467-011-1894-x. Epub 2011 May 1.
The management of steroid-dependent nephrotic syndrome, especially in patients who have failed to respond to cytotoxic drugs, such as cyclophosphamide, remains challenging. Rituximab represents a new (off-label) therapeutic option. In a significant portion of patients, it has a short serum half-life following the recovery of CD20-positive cells. The addition of mycophenolate mofetil (MMF) as a maintenance therapy is also an attractive option, but one which requires testing in a prospective randomized clinical trial with therapeutic drug monitoring and mechanistic ancillary studies.
类固醇依赖型肾病综合征的治疗，尤其是那些对环磷酰胺等细胞毒性药物反应不佳的患者，仍然具有挑战性。利妥昔单抗代表了一种新的（超适应证）治疗选择。在很大一部分患者中，CD20 阳性细胞恢复后，其血清半衰期较短。作为维持治疗添加霉酚酸酯（MMF）也是一个有吸引力的选择，但需要在具有治疗药物监测和机制辅助研究的前瞻性随机临床试验中进行测试。
