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Brief CommunicationBrief Communication
Open Access

The outcome of rituximab in treating steroid dependent nephrotic syndrome.

Histopathology and immunosuppressive drugs as predicting factors

Abdullah A. Al Salloum, Adi J. Al Herbish, Mohammed A. Al Hissi, Mohammed S. Abdalla, Suha B. Salim, Afrah H. Farhat, Reem A. Shagal, Abduldafaee Othman, Abdulelah Alshaiban, Mohamad-Hani A. Temsah, Ayman A. Al-Eyadhy and Khalid A. Alhasan
Saudi Medical Journal July 2022, 43 (7) 760-764; DOI: https://doi.org/10.15537/smj.2022.43.7.20210727
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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  • For correspondence: [email protected]
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    Table 1

    - Patients’ clinical characteristics.

    No.GenderOnset age (y)Previous ISKidney biopsyAge at RTX (y)No. of RTX infusionAdverse effectTime since last infusion (y)Last visit urine dipstickOutcome and comments
    1F4Pred, tacMCD96No2- veRemission, off medication
    2M3Pred, MMFMCD78No3traceRemission, off medication
    3F4Pred, CyAMCD116Bronchiectasis Hypogamma-globulinemia3- veRemission, on monthly IV IgG replacemen
    4F5PredMCD124No10- veRemission, off medication for 10 years
    5M6Pred, CyA, MMFMCD1012Anaphylactoid reaction to last dose24+Pred, MMF, Tac
    6M4Pred, MMFMCD94No5- veRemission, off medication for 5 years
    7M2Pred, CyAMCD44No3- veRemission, on low-dose pred
    8M3Pred, MMF, CyAIgM Nephropathy62No2- veRemission, on MMF
    9M2Pred, MMFIgM Nephropathy44No3- veRemission, off medication
    10M5Pred, MMFMCD103No9- veRemission, off medication for 9 years
    11M4Pred, MMFMCD83No8- veRemission, off medication for 8 years
    12M6Pred, CyAMCD127No3- veRemission, off medication
    13M4Pred, CyAMCD62No2TraceRemission, off medication
    14M3Pred, MMF, TacIgM Nephropathy53Allergy, itching2- veRemission on MMF
    15M2Pred, CyAFSGS42No2- veRemission on CyA
    16M2PredMCD104No2- veRemission, off medication
    17M4Pred, CyAMCD134No5- veRemission, off medication for 5 years

    No.: number, y: years, IS: immunosuppressive medication, RTX: rituximab, F: female, M: male, Pred: prednisolone, tac: tacrolimus, MMF: mycophenolate mofetil, CyA: cyclosporine A, MCD: minimal change disease, IgM: immunoglobulin M, FSGS: focal segmental glomerulosclerosis, IgG: immunoglobulin G, IV: intravenous

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      Table 2

      - Outcomes according to pre-rituximab medication.

      Pre-RTX drugNo. of patientsResponsePartial responseNo response
      Steroid alone2200
      Steroid + MMF5500
      Steroid + CNI7520
      Steroid + MMF +CNI3021

      RTX: rituximab, No.: number, MMF: mycophenolate mofetil, CNI: calcineurin inhibitors

        • View popup
        Table 3

        - Outcomes according to histopathology.

        PathologyNo. of patientsResponsePartially responseNo response
        MCD13 (76.0)11/131/31/13
        IgM nephropathy3 (18.0)1/32/30
        FSGS1 (6.0)No1/10
        Total17 (100)12/174/171/17

        Values are presented as number and precentage (%). No.: number, MCD: minimal change disease, IgM: immunoglobulin M, FSGS: focal segmental glomerulosclerosis

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        Saudi Medical Journal: 43 (7)
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        1 Jul 2022
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        The outcome of rituximab in treating steroid dependent nephrotic syndrome.
        Abdullah A. Al Salloum, Adi J. Al Herbish, Mohammed A. Al Hissi, Mohammed S. Abdalla, Suha B. Salim, Afrah H. Farhat, Reem A. Shagal, Abduldafaee Othman, Abdulelah Alshaiban, Mohamad-Hani A. Temsah, Ayman A. Al-Eyadhy, Khalid A. Alhasan
        Saudi Medical Journal Jul 2022, 43 (7) 760-764; DOI: 10.15537/smj.2022.43.7.20210727

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        The outcome of rituximab in treating steroid dependent nephrotic syndrome.
        Abdullah A. Al Salloum, Adi J. Al Herbish, Mohammed A. Al Hissi, Mohammed S. Abdalla, Suha B. Salim, Afrah H. Farhat, Reem A. Shagal, Abduldafaee Othman, Abdulelah Alshaiban, Mohamad-Hani A. Temsah, Ayman A. Al-Eyadhy, Khalid A. Alhasan
        Saudi Medical Journal Jul 2022, 43 (7) 760-764; DOI: 10.15537/smj.2022.43.7.20210727
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        Keywords

        • rituximab
        • nephrotic syndrome
        • children
        • steroid-dependent

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