The uncertainty of rituximab and steroid dosing in refractory steroid-resistant nephrotic syndrome.

摘要

Sir, - Although there is increasing evidence for the supposition that both intravenous methylprednisolone pulse (IVMP) and cyclosporine (CsA) are beneficial in the treatment of steroid-resistant nephrotic syndrome (SRNS), it is unclear whether and which rescue therapies should be offered to those patients who did not respond to this combined therapy after 6 months. In the last decade, the anti-CD20 monoclonal antibody, rituximab (RTX), has been used successfully as rescue therapy in children with refractory SRNS. In this paper we describe a child with SRNS due-to-minimal change disease (MCD) who did not respond to combined therapy with multiple IVMP, CsA, plasma exchange, and a single infusion of RTX for more than 6 months, but finally went into complete remission after an additional RTX infusion, followed by a second administration of high-dose predniso-lone (PSL) therapy.