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Al Salloum AA, Al Herbish AJ, Al Hissi MA, Abdalla MS, Salim SB, Farhat AH, Shagal RA, Othman A, Alshaiban A, Temsah MHA, Al-Eyadhy AA, Alhasan KA. The outcome of rituximab in treating steroid dependent nephrotic syndrome.: Histopathology and immunosuppressive drugs as predicting factors. Saudi Med J 2022; 43:760-764. [PMID: 35830996 PMCID: PMC9749693 DOI: 10.15537/smj.2022.43.7.20210727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To present our experience of treating steroid-dependent nephrotic syndrome (SDNS) in children with repeated doses of rituximab (RTX) with a relatively long follow-up, and to discuss the role of the histopathology type and previous immune-suppressor (IS) drugs on the outcome of these patients. METHODS The patients included in this prospective study were children with SDNS who were in remission on a high-dose steroid or with additional IS drugs. All patients underwent renal biopsy before RTX treatment. Intravenous RTX was administered monthly at 375 mg/m2 for 4 doses. Response to treatment was defined as maintaining remission with no steroid-sparing agents or prednisone for one year. RESULTS Seventeen (14 males) patients were enrolled. Approximately 76% had minimal change disease (MCD) and 3 (18%) patients had immunoglobulin M (IgM) nephropathy. Approximately 85% of MCD and 33% of IgM nephropathy showed complete response to RTX. CONCLUSION Compared to other IS used to treat SDNS, RTX showed a significant decrease in relapse rate with fewer side effects. The dose and interval should be modified according to the patient's characteristics, such as medical history, pathology type, and previous IS agents.
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Affiliation(s)
- Abdullah A. Al Salloum
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Adi J. Al Herbish
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Al Hissi
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed S. Abdalla
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Suha B. Salim
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Afrah H. Farhat
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Reem A. Shagal
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Abduldafaee Othman
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Abdulelah Alshaiban
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohamad-Hani A. Temsah
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Ayman A. Al-Eyadhy
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Khalid A. Alhasan
- From the Department of Pediatrics (Al Salloum, Al Herbish, Al Hissi, Abdallah, Salim, Farhat, Shagal, Othman, Alshiban, Temsah, Al-Eyadhy, Alhasan), College of Medicine, King Saud University, King Saud University Medical City, and from the Department of Pediatric Kidney Transplant (Alhasan), Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprints request to: Dr. Khalid A. Alhasan, Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-42918536
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