Kadikoy Huseyin, Haque Waqar, Ahmed Salman, Abdellatif Abdul
Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Saudi J Kidney Dis Transpl. 2012 Mar;23(2):334-7.
Dysfunction of the B lymphocyte, an important component of adaptive immunity, is thought to be important in the pathogenesis of lupus nephritis (LN). There are several novel strategies emerging including B-cell depletion by the monoclonal antibodies to B-cell markers, rituximab. We describe an unusual clinical response of a 22-year-old Hispanic woman with class IV LN with vasculitis while on dialysis to cyclophosphamide (CY) and adjunct rituximab. The patient had a history of class III/V LN and was treated with nine months of CY and maintenance therapy with mycophenolate mofetil (MMF) for three years. While on MMF, the patient developed class IV LN with vasculitis leading to end-stage renal disease (ESRD). While the patient was on peritoneal dialysis, the patient was treated with two doses of rituximab and six doses of intravenous CY. The patient responded to this regimen and recovered kidney function within four months. The kidney function remained stable nine months after discontinuing peritoneal dialysis.
B淋巴细胞作为适应性免疫的重要组成部分，其功能障碍被认为在狼疮性肾炎（LN）的发病机制中起重要作用。目前出现了几种新策略，包括使用针对B细胞标志物的单克隆抗体利妥昔单抗进行B细胞清除。我们描述了一名22岁患有IV级LN合并血管炎的西班牙裔女性在透析期间接受环磷酰胺（CY）和辅助利妥昔单抗治疗时出现的不寻常临床反应。该患者有III/V级LN病史，接受了9个月的CY治疗，并使用霉酚酸酯（MMF）维持治疗三年。在使用MMF期间，患者发展为IV级LN合并血管炎，导致终末期肾病（ESRD）。当患者进行腹膜透析时，接受了两剂利妥昔单抗和六剂静脉注射CY治疗。患者对该方案有反应，并在四个月内肾功能恢复。停止腹膜透析九个月后，肾功能保持稳定。
