Rituximab therapy for primary glomerulonephritis: Report on two cases

Table 1 Blood chemistries at presentation and over follow-up (patient 1)

	Admission	Discharge	Middle follow-up	Final follow-up
Creatinine (0.5-1.2, mg/dL)	2.8	1.59	1.76	0.8
Blood urea nitrogen (8-20, mg/dL)	147	104	86	85
AST (5-32, IU/L)	12	24	27	23
ALT (5-31, IU/L)	9	43	39	7
γGT (5-36, IU/L)	12	44	41	69
Cholinesterasis (5300-12900, IU/L)	3833	2160	2920	3173
Total bilirubin (0.2-1.1, mg/dL)	0.2	0.25	0.22	0.23
Direct bilirubin (0-0.3, mg/dL)	0.09	0.07	0.08	0.16
Total protein (6.6-8.7, g/dL)	3.9	4.6	4.6	4.5
Albumin (3.4-4.8, g/dL)	2.4	3	2.5	3
Prothrombin time (0.88-1.16)	1.08	1.07	1.06	1.08
Partial thromboplastin time (0.85-1.18)	1.01	1	1.03	1.19
C3 (90-180)	20	56	59	99
C4 (10-40)	0	1	3	2
Cryoglobulins	Present	Absent	Absent	Present
Leucocytes (4.8-10.8, 103/mmc)	10670	3440	3400	3730
Hemoglobin (12-16, g/dL)	10.8	9.7	10.2	10.5
Platelets (130-400, 103/mmc)	313000	159000	153000	73000

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; γGT: Gamma-glutamyl transpeptidase.

Table 2 Literature review: Adverse events during rituximab therapy for primary membranous and membranoproliferative glomerulonephritis

Ref.	n	Rituximab treatment dose	Follow-up period	Concomitant therapy	Response to RTX	Side-effects after RTX
Fervenza et al[2]	15	1 g × 2, on days 1 and 15	12 mo	ACE-I + ARB	Complete (n = 2) or partial remission (n = 6)	Nonserious transient AE (n = 10) pneumonia (n = 1)
Segarra [3]	13	375 mg/m2 once weekly × 4	30 mo	Tac (n = 10), CyA (n = 3), CCS (n = 3)	Partial remission (n = 13)	None
Fervenza et al[4]	20	375 mg/m2 once weekly × 4	24 mo	ACE-I + ARB	Complete (n = 4) or partial remission (n = 12)	Nonserious transient AE (n = 11) pneumonia (n = 1)
Michel et al[5]	28	375 mg/m2 once weekly × 2 or 3 or 4 (n = 27) 1 g × 2, on days 1 and 15 (n = 1)	12 mo	ACE-I + ARB, CCS (n = 1), Tac (n = 1)	Complete (n = 6) or partial remission (n = 13)	Nonserious transient AE (few)
Ruggenenti et al[6]	100	375 mg/m2 once weekly × 4	29 mo	CCS	Complete (n = 27) or partial remission (n = 38)	Nonserious transient AE (n = 28)
Dillon et al[7]	6	1 g × 2, on days 1 and 15	12 mo	ACE-I + ARB	Complete (n = 2) or partial remission (n = 3)	None
Kong et al[8]	13	500 mg × 1 (n = 6)	31.5 mo	CCS (os) (n = 9)	Remission (n = 19)	Nonserious transient AE (n = 8)
		500 mg × 2 (n = 3)		CyA (n = 2)		Pneumonia (n = 1)
		500 mg × 4 (n = 4)		CCS (iv) (n = 2)

ACE-I: Angiotensin converting enzyme inhibitors; AE: Adverse events; ARB: Angiotensin receptor blockers; CCS: Corticosteroids [by intravenous (iv) or oral (os) route]; CyA: Cyclosporine; MN: Membranous nephropathy; MPGN: Membranoproliferative glomerulonephritis; Tac: Tacrolimus; RTX: Rituximab.

Table 3 Overview of cases with non-viral hepatitis mixed cryoglobulinemia (and kidney involvement) on rituximab

Ref.	n	Age (yr)/gender	Treatment prior to RTX	Features	Response to RTX	Side-effects after RTX
Arzoo et al[28]	1	71/F	CS	C, N, R	Remission	None
Ghijsels et al[29]	1	44/M	CS, CPH, CHL	C, Ca, R	Remission	None
Koukoulaki et al[30]	1	48/F	CS, CPH	GI, P, R	Partial remission	None
Bryce et al[31]	1	NA	NA	R	No response	None
Ruch et al[32]	1	64/M	CS	R	Remission	Cold agglutinine disease, sepsis
Annear et al[33]	1	42/F	CS	C, R	Remission	None
Terrier et al[34]	7	73 ± 5/M (n = 4)	CS (n = 4)	C (n = 6), N (n = 2), A (n = 2), R (n = 7)	Remission (n = 3), partial remission (n = 1), NA (n = 3)	Severe infections (n = 4)
Wink et al[35]	1	72/F	CS, Aza	C, P, R	Remission	None
Choudhry et al[36]	1	61/F	CS, CPH	C, P, R	Remission	None
Kamel et al[37]	1	77/F	CS	C, A, R	Remission	None
Own case	1	51/M	CS, Aza	C, GI, N, R	Remission	Severe infection

A: Arthralgias; Aza: Azathioprine; C: Cutaneous; Ca: Cardiac; CHL: Chlorambucil; CPH: Cyclophosphamide; CS: Corticosteroids; GI: Gastrointestinal; N: Neurological; NA: Not available; P: Pulmonary; R: Renal; RTX: Rituximab.