Clinical Analysis Of Rituximab In The Treatment Of Idiopathic Membranous Nephropathy

Objective:(1)To study the clinical efficacy and case characteristics of rituximab in the treatment of idiopathic membranous nephropathy.(2)To study the relationship between serum PLA2R antibody titer and clinical efficacy in patients with idiopathic membranous nephropathy.Methods:(1)Subjects:A retrospective selection of 15 inpatients in the Nephrology Department of the First Hospital of Jilin University from January 2020 to March 2021 were selected,including 8(53.33%)males and 7(46.67%)females.The enrollment criteria met:(1)Meet the diagnostic criteria for nephrotic syndrome,exclude secondary factors,and be diagnosed as idiopathic membranous nephropathy;(2)Adult patients older than 18years of age;(3)Baseline PLA2R antibody positive(measured by ELISA method>5RU/m L is defined as positive);(4)Sign the informed consent form for rituximab treatment and fully understand the treatment risk;(5)Have complete clinical data:blood routine,liver and kidney function,urine protein quantification,serum PLA2R antibody and the level of B cells(CD19~+cells)in whole blood,etc.;exclusion criteria:(1)Meet the diagnostic criteria for nephrotic syndrome,after renal biopsy,pathological diagnosis is minimal change nephropathy,membranous proliferative glomerulonephritis,Patients with mesangial proliferative glomerulonephritis;(2)Patients with secondary nephrotic syndrome caused by infection,hepatitis,drugs,systemic lupus erythematosus,etc.;(3)Patients with heart failure,tuberculosis,severe active infection,recent Those who have received chemotherapy and other treatments;(4)Those who have non-Hodgkin’s lymphoma,rheumatoid arthritis,mental and neurological diseases.(2)Methods:Before rituximab treatment,pretreatment with promethazine 25mg,dexamethasone 5mg and phenytolamine 50 mg,rituximab 375 mg/m~2 or 1g infusion,once a month,retrospective collection of patients General information such as age,gender,past history,etc.,before the application of the drug,the urine routine,blood routine,blood biochemistry,24-hour urine protein quantification,CD20~+cell count,PLA2R antibody and other indicators,and the first time after the administration of rituximab The serum albumin level,24-hour urine protein quantification,serum creatinine level,and PLA2R antibody were repeatedly collected during each follow-up for 1,2,3,4,and 6 months.Analyze the characteristics of patients’cases,use SPSS24 statistical software to analyze and compare the changes of clinical biochemical indicators and adverse reactions of 15 patients before treatment and at 6months of treatment,and evaluate the treatment of rituximab in the treatment of idiopathic membranous nephropathy and refractory relapse The clinical efficacy of membranous nephropathy.Results:After RTX treatment in 15 patients with IMN,proteinuria decreased from9.42±4.84 g/24 hours to 4.79±4.75 g/24 hours(P<0.05)and serum albumin increased from 21.13±4.69 to 33.34 at 6 months of follow-up.±7.63 g/L(P<0.05),PLA2R antibody titer decreased from 57.07(34.26,100.00)to 0.00(0.00,23.67)RU/ml(P<0.01).There was no statistical difference in serum creatinine before and after treatment,(P>0.05).9 out of 15 patients(60.00%)24 hours after rituximab treatment,the urine protein quantitatively decreased,and the serum albumin level increased(P<0.05).A total of 8 patients(53.33%)achieved partial remission,and 2(13.33%)patients achieved complete remission.After rituximab treatment,all patients achieved PLA2R antibody depletion or reduction,and reached B cell depletion.The renal function of the patients remained stable before and after treatment,and no obvious adverse reactions were seen.Conclusions:The effectiveness and safety of low-dose rituximab in the treatment of IMN are better.It can induce proteinuria,serum albumin improvement and stable renal function in patients with IMN.RTX still has a good effect on relapsed or refractory MN that is not well treated with glucocorticoid combined with immunosuppressive therapy.Evaluating the PLA2R antibody and urinary protein quantification in patients’serum helps to monitor the disease activity of patients with IMN and guide patients’individualized RTX treatment.