Intravenous Rituximab in Severe Refractory Primary Focal Segmental Glomerulosclerosis

Gan Wee Leng, Ruslinda Mustafar, Lydia Kamaruzaman, Rozita Mohd, Rizna Abdul Cader, Kong Wei Yen, Pau Kiew Bing

Research output: Contribution to journalArticle

Abstract

Managing primary or even secondary glomerulonephritis remains a challenge to many nephrologists. In primary focal segmental glomerulosclerosis (FSGS) with heavy proteinuria, renin aldosterone system blockade and high dose of oral prednisolone is the mainstay of treatment. Other immunosuppressive medications like Cyclophosphamide, Cyclosporine A and Mycophenolate Mofetil (MMF) are warranted if a complete remission is not achieved.  We illustrate a case of 21 year old gentleman with primary FSGS that was difficult to achieve remission despite on high dose steroid and oral Cyclophosphamide. He was also not responsive to a combination of MMF and Cyclosporine A (CSA) and even throughout the therapy he developed significant steroid and CSA toxicity. He presented to our center with severe nephrotic syndrome and acute kidney injury requiring acute haemodialysis. Despite re-challenged him again on high dose prednisolone, total of 2.4g of intravenous Cyclophosphamide, and MMF, he failed to achieve remission. He was subsequently given intravenous Rituximab 500mg/weekly for 4 doses and able to attained remission for 1 year. He relapsed again and a second course of Rituximab 500mg/weekly for 6 doses were given to attain remission. This case demonstrates the difficulty in managing refractory steroid dependent FSGS and we found that Rituximab is proven beneficial in this case to induce remission.

Original languageEnglish
Pages (from-to)237-243
Number of pages7
JournalActa medica Indonesiana
Volume50
Issue number3
Publication statusPublished - 1 Jul 2018

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Mycophenolic Acid
Focal Segmental Glomerulosclerosis
Cyclophosphamide
Cyclosporine
Steroids
Prednisolone
Nephrotic Syndrome
Immunosuppressive Agents
Glomerulonephritis
Aldosterone
Proteinuria
Acute Kidney Injury
Renin
Renal Dialysis
Therapeutics
Rituximab

Keywords

  • intravenous Rituximab
  • refractory focal segmental glomerulosclerosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Intravenous Rituximab in Severe Refractory Primary Focal Segmental Glomerulosclerosis. / Wee Leng, Gan; Mustafar, Ruslinda; Kamaruzaman, Lydia; Mohd, Rozita; Abdul Cader, Rizna; Wei Yen, Kong; Kiew Bing, Pau.

In: Acta medica Indonesiana, Vol. 50, No. 3, 01.07.2018, p. 237-243.

Research output: Contribution to journalArticle

Wee Leng, Gan ; Mustafar, Ruslinda ; Kamaruzaman, Lydia ; Mohd, Rozita ; Abdul Cader, Rizna ; Wei Yen, Kong ; Kiew Bing, Pau. / Intravenous Rituximab in Severe Refractory Primary Focal Segmental Glomerulosclerosis. In: Acta medica Indonesiana. 2018 ; Vol. 50, No. 3. pp. 237-243.
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