Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2015; 3(8): 736-742
Published online Aug 16, 2015. doi: 10.12998/wjcc.v3.i8.736
Rituximab therapy for primary glomerulonephritis: Report on two cases
Fabrizio Fabrizi, Donata Cresseri, Giovanni B Fogazzi, Gabriella Moroni, Patrizia Passerini, Paul Martin, Piergiorgio Messa
Fabrizio Fabrizi, Donata Cresseri, Giovanni B Fogazzi, Gabriella Moroni, Patrizia Passerini, Piergiorgio Messa, Division of Nephrology, Maggiore Hospital, IRCCS Foundation, 20122 Milano, Italy
Paul Martin, Division of Hepatology, School of Medicine, University of Miami, Florida, FL 33124, United States
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: Maggiore Hospital, IRCCS Foundation, Milano, Italy gave the permission to publish the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare they have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabrizio Fabrizi, MD, Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Pad. Croff, via Commenda 15, 20122 Milano, Italy. fabrizi@policlinico.mi.it
Telephone: +39-2-55033525 Fax: +39-2-55033770
Received: September 28, 2014
Peer-review started: September 29, 2014
First decision: December 17, 2014
Revised: January 10, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: August 16, 2015
Processing time: 326 Days and 14 Hours
Abstract

The evidence in the medical literature on the efficacy and safety of rituximab therapy for primary glomerulonephritis is limited and controversial. We describe two male Caucasian patients with rapidly progressive kidney failure due to primary proliferative glomerulonephritis. Both of them received high-dose intravenous corticosteroids and oral cyclophosphamide with limited benefit. The first patient (hepatitis C virus-negative mixed cryoglobulinemia) underwent plasma-exchange with intravenous immunoglobulins; he showed significant benefit on kidney function (he became dialysis independent with serum creatinine going back to 1.6 mg/dL) after one rituximab pulse even if urinary abnormalities were still present. No improvement in renal function or urinary changes occurred in the second patient. Both these individuals developed sepsis over the follow-up, the first patient died two months after rituximab therapy. This report is in keeping with the occurrence of severe infections after rituximab therapy in patients with renal impairment at baseline and concomitant high-dose steroids.

Keywords: Chronic kidney disease; Cryoglobulinemic vasculitis; Membranoproliferative glomerulonephritis; Rituximab

Core tip: A small but growing body of evidence is emerging on the efficacy and safety of rituximab therapy for primary glomerulonephritis. Various authors have claimed that rituximab for glomerular diseases is effective and has minimal adverse effects. We report on two male Caucasian patients who were refractory to conventional immunosuppressive therapy; each of them received one rituximab pulse and developed sepsis over the follow-up, the first patient died two months after rituximab therapy. The risks (and the predictive factors) of severe infections in kidney patients on rituximab therapy are unclear and appear an area of active research.