Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
Division of Nephrology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
Korean J Intern Med. 2022 Jul;37(4):830-840. doi: 10.3904/kjim.2021.155. Epub 2022 Apr 15.
BACKGROUND/AIMS: Membranous nephropathy (MN) is a major cause of nephrotic syndrome in adults. This study aimed to evaluate the effect of rituximab (RTX) in patients with idiopathic MN (iMN) who have a high risk of progression.
We retrospectively analyzed data of 13 patients with iMN, who received RTX treatments from January 2014 to July 2020. RTX was indicated in patients with iMN with severe proteinuria and decreasing estimated glomerular filtration rate (eGFR) in the previous 6 months despite other immunosuppressive therapies.
The patients were predominantly males (n = 11) and with a mean age of 55.3 years; median eGFR, 37.0 mL/min/1.73 m2 (interquartile range [IQR], 26.3 to 66.5); serum albumin level, 2.6 g/dL (IQR, 1.9 to 3.1); and spot urine protein-to-creatinine ratio at baseline, 6.6 g/g (IQR, 5.7 to 12.9). In a median follow-up of 22 months, eight patients (61.5%) achieved complete or partial remission. In responder group (n = 8), median eGFR increased from 31.5 to 61.5 mL/min/1.73 m2 (p = 0.049) and serum albumin level increased from 2.3 to 4.2 g/dL (p = 0.017) from RTX initiation to last follow-up. Antiphospholipase A2 receptor antibody (anti-PLA2R-Ab) was positive in six among seven tested patients, which markedly decreased in the responder group. There were no adverse events after RTX.
This study suggests that RTX is a safe and effective treatment option for patients with iMN who have a high risk of progression. Individualized therapy based on anti-PLA2R-Ab titer would be needed for better outcomes.
背景/目的：膜性肾病（MN）是成人肾病综合征的主要病因。本研究旨在评估利妥昔单抗（RTX）治疗特发性 MN（iMN）高危进展患者的疗效。
我们回顾性分析了 2014 年 1 月至 2020 年 7 月期间接受 RTX 治疗的 13 例 iMN 患者的数据。RTX 适用于伴有大量蛋白尿且在过去 6 个月内估计肾小球滤过率（eGFR）下降的 iMN 患者，尽管接受了其他免疫抑制治疗。
患者主要为男性（n = 11），平均年龄为 55.3 岁；中位 eGFR 为 37.0 mL/min/1.73 m2（四分位距[IQR]，26.3 至 66.5）；血清白蛋白水平为 2.6 g/dL（IQR，1.9 至 3.1）；基线时尿蛋白与肌酐比值中位数为 6.6 g/g（IQR，5.7 至 12.9）。中位随访 22 个月时，8 例（61.5%）患者获得完全或部分缓解。在应答者组（n = 8）中，eGFR 中位数从 RTX 起始时的 31.5 增加到最后一次随访时的 61.5 mL/min/1.73 m2（p = 0.049），血清白蛋白水平从 2.3 增加到 4.2 g/dL（p = 0.017）。在 7 例接受检测的患者中，有 6 例抗磷脂酶 A2 受体抗体（anti-PLA2R-Ab）阳性，在应答者组中显著降低。RTX 后无不良反应。
本研究表明，RTX 是高危进展 iMN 患者的一种安全有效的治疗选择。基于抗-PLA2R-Ab 滴度的个体化治疗可能会获得更好的结果。
