| Objectives1.To summarize the clinical and pathological characteristics of patients with refractory nephropathy treated with rituximab in our hospital,and explore its efficacy and safety;2.Summarize the clinical and pathological characteristics of patients with idiopathic membranous nephropathy treated with rituximab in our hospital,and explore the effect of rituximab treatment on the level of PLA2R antibody in patients with idiopathic membranous nephropathy.Methods1.A total of 101 patients hospitalized with primary nephrotic syndrome and receiving rituximab from January 2019 to January 2022 were enrolled.Clinical data were collected and divided into the initial treatment group and the refractory group according to whether or not rituximab was used as the initial treatment.Changes in relevant indicators before and after treatment were compared to evaluate the remission rate and incidence of adverse events.2.Clinical data of 84 patients diagnosed with idiopathic membranous nephropathy(IMN)and treated with rituximab from January 2019 to January 2022 were collected to explore the effect of rituximab on PLA2R antibody during the treatment of IMN.Results1.A total of 101 patients diagnosed with primary nephrotic syndrome and receiving rituximab were included in this study,those receiving rituximab as initial treatment were in the initial treatment group(n=31),and those receiving rituximab as second-line treatment were in the refractory group(n=70).Most of the subjects were middle-aged patients with long course of disease and follow-up.The pathological types of patients in both the initial treatment group and the refractory group were mainly membranous nephropathy,with 29 cases(93.55%)in the initial treatment group and 55 cases(78.57%)in the refractory group.In the refractory group,20 patients(28.57%)had previously received two or more different treatment regimens of glucocorticoid combined TAC and glucocorticoid combined CTX,56 patients(80%)had received glucocorticoid combined TAC,and 29 patients(41.43%)had received glucocorticoid combined CTX.Nine patients(12.86%)had received glucocorticoid monotherapy,5 patients(7.14%)had received Traditional Chinese medicine therapy,and 15 patients(21.43%)had received leflunomide,monocorticoid and other drugs.2.Among the 101 patients included,there were statistically significant differences between the newly treated group(n=31)and the refractory group(n=70)in serum creatinine,urea nitrogen,cystatin,24-hour urine protein,total B cell absolute number and other indicators before THE use of RTX.There was no statistical difference in serum uric acid,NGAL,total cholesterol,triglyceride,homocysteine,albumin,globulin,eGFR,white blood cell count,neutrophil count,absolute number of T helper cells between the newly treated group and the refractory group.3.Among the 101 patients included,the treatment situation of the newly treated group(n=31)and the refractory group(n=70)during the follow-up period:the serum creatinine.albumin,eGFR and 24-hour urinary protein in the newly treated group were gradually improved during the follow-up period,and the absolute number of total B cells was continuously depleted.At 6 months follow-up.CR or PR was achieved in 24 of the 31 patients in the newly treated group and 45 of the 70 patients in the refractory group.There was no significant difference in remission rate between the newly treated group and the refractory group at 6 months follow-up(P>0.05).At 12 months follow-up,CR or PR was achieved in 8 out of 10 patients in the newly treated group and 12 out of 19 patients in the refractory group.There was no significant difference in remission rate between the newly treated group and the refractory group at 12 months follow-up(P>0.05).4.A total of 84 patients diagnosed with idiopathic membranous nephropathy(IMN)receiving rituximab were included in this study,those receiving rituximab as initial treatment were in the initial treatment group(n=29),and those receiving rituximab as second-line treatment were in the refractory group(n=55),The initial serum creatinine level in the initial treatment group was lower than that in the refractory group(102.59±32.43 VS 74.63±21.88,P<0.05).There were no significant differences in albumin,eGFR,24-hour urine protein,PLA2R antibody and total B cell absolute number(/uL)between the two groups(P>0.05).5.Among 84 patients diagnosed with idiopathic membranous nephropathy(IMN)and treated with rituximab,51 patients underwent renal biopsy histopathological examination in our hospital,including 23 patients in the initial treatment group,17 patients with stage Ⅰmembranous nephropathy and 6 patients with stage Ⅱ membranous nephropathy.In the refractory group,there were 28 cases,21 cases of stage Ⅰ membranous nephropathy and 7 cases of stage Ⅱ membranous nephropathy.There was no significant difference in pathological stages between the untreated group and the refractory group(P>0.05).There were higher PLA2R and Clq deposition in renal pathology in the initial treatment group than in the refractory group,and the difference was statistically significant(P<0.05).There were no significant differences in IgM deposition,IgG deposition,C3 deposition,mild renal tubule atrophy,mesangial cell proliferation,matrix hyperplasia and focal segmental sclerosis between the newly treated group and the refractory group(P>0.05).Immunofluorescence indicated Kappa and Lambda positive in 23 patients(100%)in the newly treated group,and Kappa and Lambda positive in 26 patients(92.86%)in the refractory group.All patients in the newly treated group and refractory group were found to have spike formation and diffuse thickening of the basement membrane of glomerular capillaries with subepithelial polyerythrophilic deposition under light microscopy.6.A total of 84 patients diagnosed with idiopathic membranous nephropathy(IMN)receiving rituximab treatment were included in this study.Treatment of patients in the newly treated group(n=29)and refractory group(n=55)during the follow-up period:there was no statistical difference in PLA2R antibody level between the newly treated group and refractory group before rituximab treatment(P>0.05).After six months of rituximab treatment,the PLA2R antibody level in the newly treated group was significantly lower than the initial value(21.06±4.69 VS 116.89±23.76,P<0.05),and that in the refractory group was significantly lower than the initial value(25.71±3.70 VS 120.24±23.53,P<0.05).P<0.05).After 6 months of rituximab treatment,the PLA2R antibody level in the newly treated group was lower than that in the refractory group(21.06±4.69 VS 25.71±3.70,P<0.05).Conclusion.1.Rituximab can effectively treat refractory nephrotic syndrome and facilitate hormone and immunosuppressant dose reduction,but it is still necessary to be alert to the occurrence of adverse reactions such as infections and severe allergic reactions,with a high overall safety profile.2.Rituximab in the treatment of idiopathic membranous nephropathy is beneficial for disease remission,stabilization or improvement of renal function,and still has good efficacy in relapsed and refractory membranous nephropathy that is poorly treated with glucocorticoids combined with immunosuppressive regimens.3.All patients achieved depletion or reduction of PLA2R antibodies after rituximab treatment,and assessment of PLA2R antibodies and urine protein quantification in patients’serum can help monitor disease activity and guide the development of individualized treatment plans for patients with IMN. |
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