Multi-Drug Therapy Followed By Rituximab in Children with Refractory Nephrotic Syndrome Contributors
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 1
Abstract
Introduction: Over the last few years, rituximab (RTX) has emerged as a second- line therapy and has shown a 40-48% response rate in steroid resistant and up to 80% remission rate in steroid dependent nephrotic syndrome. The better outcome of RTX therapy in dependent nephrotic syndrome compared to resistant nephrotic syndrome is possibly due to excessive loss of RTX in the urine during active state of proteinuria. Objective: To assess the therapeutic response of RTX during non-proteinuric state in children with steroid and CNIs/MMF resistance nephrotic syndrome following induction of remission by a combined therapy of Prednisolone, CNIs and MMF. Materials and Methodology: In this study we analysed the data of steroid and CNIs/MMF –resistance idiopathic nephrotic children, aged 1-14 years from January 2014 to January 2016. The clinical decision was to treat those patients with a combined therapy (Prednisolone+CNI+MMF) to achieve remission, followed by treatment with RTX at a dose of 375 mg/m2 body surface area per week for two to four weeks. Five children those who responded to triple regimen were treated with two to four doses of RTX and were followed up for minimum six months following RTX therapy. Post RTX therapy, CNI and prednisolone dose was tapered. Results and Discussion: The characteristics of the five patients and follow-up data were documented Patient 1 and 2 were twin brothers. At six months follow-up, four patients achieved complete remission (80%) and three patients (60%) were completely off medications without any serious adverse effects. Conclusion: Ourstudy showed improved RTX efficacy during non-proteinuric state of refractory nephrotic syndrome. However, as intense immunosuppression may cause serious adverse event further study for evaluatinglong-term efficacy and safety of multidrug therapy are needed.
Authors and Affiliations
r. Saroj Kumar Satpathy, Dr. Subal Kumar Pradhan, Dr. Akhil Krishnamoorthy, Dr. Shreesh Bhat
Keywords
Related Articles
- EP ID EP262843
- DOI 10.9790/0853-1701010
- Views 75
- Downloads 0
A Prospective, Randomized Controlled Study To Compare Changes In Endotracheal Tube Cuff Pressure During General Anaesthesia Using Nitrous Oxide Between Air And Distilled Water Cuff Inflation Using Pressure Gauge And Pressure Transducer.
Summary: In this prospective, randomized controlled study, we studied endotracheal tube cuff pressure changes in 100 patients undergoing elective surgical procedures requiring general anaesthesia with oxygen and nitrous...
Knowledge and awareness about dental implants as replacement of missing teeth among a small population in Anantnag
Aim The aim of the study was to assess the awareness of the patients regarding dental implants as an option for tooth replacement including knowledge about it and standpoint towards it amongst a small population in Anant...
Efficacy and Safety Assessment of Acotiamide and Levosulpiride in Functional Dyspepsia
Aim: To assess the Efficacy and Safety of Acotiamide and Levosulpiride in Functional Dyspepsia Methods: Total 60 patients were selected for the study.Patients were divided into 2 groups. Group A received 100mg acotiamide...
Myths about Usage of Beta-Blockers
Background: Beta-blocker therapy has a proven benefit in patients with hypertension, heart failure and Coronary Artery Disease (CAD) and have been considered contraindicated in patients with Chronic Obstructive Pulmonary...
Mutant IDH 1 Expression in Non-Neoplastic And Neoplastic NonMelanoma Epithelial Skin Lesions; IHC Expression And Clinicopathological Relations
Background: Cellular metabolism is known to be altered in cancer cells which switch to glycolysis and lactate fermentation for ATP production (Warburg Effect) providing a growth advantage for cancer cells. The “Warburg E...