Rituximab treatment of idiopathic membranous nephropathy
Rituximab treatment of idiopathic membranous nephropathy
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DOI：
10.1038/sj.ki.5002628
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发表时间：
2008-01-01
影响因子：
19.6
通讯作者：
Cattran, D. C.
中科院分区：
文献类型：
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作者：
Fervenza, F. C.;Cosio, F. G.;Cattran, D. C.
特发性膜性肾病是肾病综合征的常见原因，其发病机制可能涉及B细胞功能。利妥昔单抗是一种单克隆抗体，可与 B 细胞上的 CD20 抗原结合，从而将其删除。我们对 15 名患有蛋白尿的严重肾病患者进行了一项利妥昔单抗治疗的开放标签试验，这些患者对血管紧张素转换酶抑制和/或受体阻断难以治疗，但血压得到充分控制。利妥昔单抗治疗间隔 2 周，6 个月时，仍存在蛋白尿但 B 细胞计数已恢复的患者接受第二个疗程。 12 个月时蛋白尿显着减少约一半。在完成随访的 14 名患者中，根据蛋白尿的程度，2 名患者实现完全缓解，6 名患者获得部分缓解。副作用很小；然而，我们发现反应与血液中 B 细胞数量、肾活检中 CD20 细胞数量、肾小管间质纤维化程度、起始蛋白尿或肌酐值之间没有关系。利妥昔单抗似乎可以有效减少某些特发性膜性肾病患者的蛋白尿，但无法前瞻性识别有反应的患者。
Idiopathic membranous nephropathy is a common cause of nephrotic syndrome whose pathogenesis may involve B-cell functions. Rituximab is a monoclonal antibody that binds to the CD20 antigen on B cells thereby deleting them. We conducted an open-label pilot trial of rituximab treatment in 15 severely nephrotic patients with proteinuria refractory to angiotensin-converting enzyme inhibition and/or receptor blockade but with adequately controlled blood pressure. Rituximab was given 2 weeks apart and, at 6 months, patients who remained proteinuric but had recovered B-cell counts were given a second course of treatment. Proteinuria was significantly decreased by about half at 12 months. Of the 14 patients who completed follow-up, full remission was achieved in two and partial remission in six patients based upon the degree of proteinuria. Side effects were minor; however, we found no relationship between the response and number of B cells in the blood, CD20 cells in the kidney biopsy, degree of tubulointerstitial fibrosis, starting proteinuria or creatinine values. Rituximab appears effective in reducing proteinuria in some patients with idiopathic membranous nephropathy but prospective identification of responsive patients was not possible.