Successful Pregnancies in a Patient with Childhood-onset Steroid-dependent Nephrotic Syndrome during Rituximab Maintenance Therapy

Treatment of nephrotic syndrome with anti-CD20 therapies in pregnancy: a case series and review of the literature

Membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) are autoimmune kidney diseases and the most common causes of nephrotic syndrome. Anti-CD20 monoclonal antibodies are now recommended as first-line therapy for MN. Anti-CD20 monoclonal antibodies are also effective in steroid-dependent or frequently relapsing nephrotic syndrome associated with MCD or FSGS. Many women eligible for these treatments are of childbearing age. The impact of anti-CD20 therapies on pregnancy and fetal outcomes remains uncertain, particularly in glomerular diseases. We describe three cases of patients with glomerular disease treated with anti-CD20 therapies in the context of pregnancy and review the literature.

Glomerular diseases in pregnancy: pragmatic recommendations for clinical management

Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.