Two cases report of low dose rituximab therapy for refractory nephrotic syndrome and literature review

Objective To explore the mechanism, curative effect and existing problems of rituximab therapyforpatientswith refractory nephrotic syndrome through analysis of 2 typical cases and literature review. Methods The clinical characteristics and effects of low dose rituximab for two patients with refractory nephrotic syndrome were retrospectively analyzed and the related literatures were reviewed. Results Case 1 was diagnosed as stage Ⅱ membranous nephropathy by renal biopsy. Glucocorticoids and commonly used immunosuppressants (cyclophosphamide, tacrolimus, mycophenolatemofetil) had poor efficacy and the disease could not be alleviated. After administration of rituximab (100 mg) permonth for 3 months, serum albumin was significantly elevated, serum creatinine was decreased, eGFR was increased, urinary protein was significantly reduced, and patient achieved partial remission. Case 2 given glucocorticoid in combination with mycophenolatemofetil, cyclophosphamide andtacrolimus could be relieved, but frequent relapses occurred during drugs reduction.Complete remission could be achieved after a single rituximab (100mg) treatment. The albumin level increased to the normal level, and urinary protein turned negative.There was no obvious adverse reaction during the treatment. Conclusions Low dose rituximab is a safe and effective treatment for refractory nephrotic syndrome.