Hogan Jonathan, Restivo Michaela, Canetta Pietro A, Herlitz Leal C, Radhakrishnan Jai, Appel Gerald B, Bomback Andrew S
Division of Nephrology, Department of Medicine,Columbia University Medical Center, New York, NY, USA.
Nephrol Dial Transplant. 2014 Oct;29(10):1925-31. doi: 10.1093/ndt/gfu189. Epub 2014 May 27.
Approximately 50% of patients with fibrillary glomerulonephritis (GN) progress to end-stage renal disease (ESRD) within 2 years of diagnosis, and no standard therapy exists. The data on rituximab therapy for fibrillary GN are limited and have inconsistent outcomes. Here, we report the largest case series to date using rituximab for fibrillary GN.
Retrospective chart reviews were conducted on 12 patients with fibrillary GN who were treated with rituximab (1 g i.v. × 2 doses or 375 mg/m(2) × 4 doses) at the Center for Glomerular Diseases at Columbia University Medical Center. Non-progression of disease was defined as stable/improved serum creatinine (SCr) with a minimum of 1 year of follow-up.
The median SCr was 2.1 (range 0.7-2.7) mg/dL, median estimated glomerular filtration rate (eGFR) 39 (range 21-98) mL/min/1.73 m(2) and median proteinuria 4497 (range 210-7542) mg/day at the time of rituximab initiation. Four patients had received immunosuppression before rituximab, and nine received immunosuppression after rituximab, with four receiving a second rituximab course. Four of 12 patients were non-progressors, 3 of 12 had progressive renal dysfunction without reaching ESRD, and 5 patients reached ESRD. The median follow-up for patients who did not reach ESRD was 38 (range 14-76) months after rituximab treatment. Non-progressors had lower SCr values, higher eGFRs and shorter median duration from diagnosis to treatment than progressors. No serious adverse events were noted.
Rituximab therapy was associated with non-progression of renal disease in 4 of 12 patients. At the time of treatment, these non-progressors had better renal function and shorter time from diagnosis to treatment than progressors.
约50%的纤维性肾小球肾炎（GN）患者在诊断后2年内进展至终末期肾病（ESRD），且尚无标准治疗方法。关于利妥昔单抗治疗纤维性GN的数据有限，结果也不一致。在此，我们报告了迄今为止使用利妥昔单抗治疗纤维性GN的最大病例系列。
对哥伦比亚大学医学中心肾小球疾病中心接受利妥昔单抗治疗（静脉注射1 g×2剂或375 mg/m²×4剂）的12例纤维性GN患者进行回顾性病历审查。疾病无进展定义为血清肌酐（SCr）稳定/改善，且至少随访1年。
开始使用利妥昔单抗时，SCr中位数为2.1（范围0.7 - 2.7）mg/dL，估计肾小球滤过率（eGFR）中位数为39（范围21 - 98）mL/min/1.73 m²，蛋白尿中位数为4497（范围210 - 7542）mg/天。12例患者中有4例在使用利妥昔单抗前接受过免疫抑制治疗，9例在使用利妥昔单抗后接受过免疫抑制治疗，其中4例接受了第二个利妥昔单抗疗程。12例患者中有4例疾病无进展，12例中有3例出现进行性肾功能不全但未达到ESRD，5例患者进展至ESRD。未达到ESRD的患者在利妥昔单抗治疗后的中位随访时间为38（范围14 - 76）个月。疾病无进展者的SCr值较低，eGFR较高，从诊断到治疗的中位时间比疾病进展者短。未观察到严重不良事件。
12例患者中有4例接受利妥昔单抗治疗后疾病无进展。在治疗时，这些疾病无进展者的肾功能优于疾病进展者，且从诊断到治疗的时间更短。
