Miguel Liern, Servicio de Nefrología, Hospital General de Niños Ricardo Gutierrez, Buenos Aires, Argentina
Ana Caturia, Servicio de Nefrología, Hospital General de Niños Ricardo Gutierrez, Buenos Aires, Argentina
Maia Loretti, Servicio de Nefrología, Hospital General de Niños Ricardo Gutierrez, Buenos Aires, Argentina
Introduction: Idiopathic nephrotic syndrome (INS) in children may present frequent relapses or steroid dependence, with a risk of corticosteroid toxicity. In this context, rituximab (RTX) and mycophenolate mofetil (MMF) were used as alternative therapeutic options. Materials and methods: A prospective observational cohort study was conducted in a pediatric nephrology unit in the Autonomous City of Buenos Aires, including 12 patients with steroid-dependent nephrotic syndrome (SDNS) who received sequential treatment with RTX and MMF. Results: Of the 12 patients treated with RTX, 4 achieved sustained remission. The remaining 8 had fewer than 2 relapses per year but required potentially toxic steroid doses; therefore, after a mean period of 13 months post-RTX, MMF was added. All patients remained in remission until the end of the study. The cumulative steroid dose (CSD) pre-RTX was 5335 mg/m2 and post-RTX was 2024 mg/m2 (p = 0.001). Finally, the mean CSD with MMF was 1378 mg/m2 (Wilcoxon test: T = 3.5, p = 0.005). In the 10 patients who experienced at least one relapse, the mean CD20 lymphocyte count one month after RTX was 3.7 cells/mm3, and at relapse it was 26 cells/mm3 (CD20–proteinuria correlation coefficient: 0.54). Observed adverse effects were minimal and reversible. Conclusion: Sequential therapy with RTX and MMF may be an option for patients with primary steroid-dependent nephrotic syndrome.
Keywords: Mycophenolate mofetil. Steroid dependent nephrotic síndrome. Rituximab.
