Rituxan for glomerulonephritis – pro
Membranous nephropathy remains the most common cause of idiopathic nephrotic syndrome in Caucasians in western countries. Most idiopathic membranous nephropathy is likely related to the production of autoantibodies to the M-type phospholipase A2 receptor, which combine in situ with its antigen target in a glomerular subepithelial location.1 Currently, Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend using a regimen of alternating months of corticosteroids and alkylating agent for 6 months as first-line therapy for idiopathic membranous nephropathy, and if this fails use of a calcineurin inhibitor.2. Rituximabis recommended second line, for fully nephrotic patients at high risk of progression who have failed both first line treatments of alternating months of corticosteroids and an alkylating agent, or calcineurin inhibitors. Before choosing a course of rituximab, consideration should also be given to other available therapies including continuous noncyclic use of oral alkylating agents, adrenocorticotropic hormone, or mycophenolate mofetil, which have also been studied in membranous nephropathy.3
1.Ronco P, Debiec H: Antigen identification in membranous nephropathy moves toward targeted monitoring and new therapy. J Am Soc Nephrol 21: 564569, 2010
2.KDIGO: Clincial practice guidelines for glomerulonephritis. Kidney Int Suppl2: 186197, 2012.
3.J.A.Appel, Rituximab in Membranous Nephropathy: Is It a First-Line Treatment? JASN August 1, 2012 vol. 23 no. 8 1280-1282