Zhang Xiaojing, Jin Yanyan, Liu Fei, Li Qiuyu, Xie Yi, Huang Guoping, Chen Junyi, He Xue, He Siyi, Fu Haidong, Wang Jingjing, Shen Huijun, Mao Jianhua
Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
Department of Pediatrics, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Clin Kidney J. 2024 Nov 18;18(1):sfae348. doi: 10.1093/ckj/sfae348. eCollection 2025 Jan.
Idiopathic nephrotic syndrome (INS) in children, commonly treated with steroids, poses challenges due to associated side effects. Rituximab, known for its efficacy in reducing relapse frequency in difficult-to-treat cases, emerges a potential first-line therapy for pediatric new-onset INS.
This is a single-center, retrospective, observational study to evaluate the efficacy and safety of rituximab as a first-line therapy for pediatric INS. The complete treatment strategy was weekly injections at a dose of 375 mg/m for four doses. Children with new-onset INS who received rituximab as a first-line monotherapy from 1 January 2022 to 31 December 2023 were included and followed until 31 May 2024.
Seventeen patients (median age at diagnosis 4.8 years) were included. Twelve patients achieved complete remission within a median time of 19 days. Over a follow-up period ranging from 41 to 112 weeks, 11 patients maintained remission even after B-cell reconstitution, with one patient experiencing a relapse at 85 weeks. Three patients, who presented with hematuria, hypocomplementemia or renal injury at initial diagnosis, exhibited resistance to rituximab. No severe adverse events were noted.
Rituximab may be an effective and safe option as a first-line therapy for inducing and maintaining remission in newly diagnosed INS.
儿童特发性肾病综合征（INS）通常采用类固醇治疗，但因其相关副作用而面临挑战。利妥昔单抗以其在难治性病例中降低复发频率的疗效而闻名，成为小儿新发INS的潜在一线治疗方法。
这是一项单中心、回顾性、观察性研究，旨在评估利妥昔单抗作为小儿INS一线治疗的疗效和安全性。完整的治疗方案是每周注射一次，剂量为375mg/m²，共注射四剂。纳入2022年1月1日至2023年12月31日期间接受利妥昔单抗作为一线单药治疗的新发INS患儿，并随访至2024年5月31日。
纳入17例患者（诊断时中位年龄4.8岁）。12例患者在中位时间19天内实现完全缓解。在41至112周的随访期内，11例患者即使在B细胞重建后仍维持缓解，1例患者在85周时复发。3例在初诊时出现血尿、低补体血症或肾损伤的患者对利妥昔单抗耐药。未观察到严重不良事件。
利妥昔单抗作为新诊断INS诱导和维持缓解的一线治疗可能是一种有效且安全的选择。
