Retrospektive Auswertung des Einflusses von Rituximab auf den Krankheitsverlauf immunvermittelter Erkrankungen der Niere

Abstract

Background and study design Rituximab is increasingly being used in the treatment of patients with kidney diseases. We evaluated our clinical experience at the Ulm University Hospital. Setting and Participants Since 2004, we have administered rituximab as rescue therapy to twenty-six patients with kidney diseases non-responsive to standard treatment. Indications for rituximab were progressive loss of kidney function in thirteen cases; nephrotic syndrome in five cases; humoral rejection after kidney transplantation in five cases and single cases of pre-emptive elimination of ABO incompatible antibodies, pre-transplant elimination of panel-reactive antibodies (PRA), and post-transplant lymphoproliferative disease (PTLD). Outcomes, measurements, results and limitations Kidney function recovered in five of thirteen cases (median creatinine 478 µmol/l before and 236 µmol/l after rituximab). Nephrotic syndrome responded in two of five cases (median proteinuria 8.2 g/day before and 0.9 g/day after rituximab). In two of five patients with humoral rejection the kidney transplant function could be preserved for more than 6 months. Pre-emptive antibody reduction was efficient in both cases, and the patient with PTLD could be brought to remission. Toxic leukoencephalopathy was a serious but reversible complication in three cases that occurred particularly after administration of high dose rituximab. Conclusion Rituximab rescue was successful in almost 50% of our cases (12 of 26). Overall rituximab was well tolerated, but toxic leukoencephalopathy turned out as a significant complication.