Advancing the Treatment of Adult Steroid-Resistant Nephrotic Syndrome: The Role of Rituximab

Background: Steroid-resistant nephrotic syndrome (SRNS) in adults presents a significant therapeutic challenge, often leading to end-stage kidneys. This study aims to evaluate the clinical outcomes of rituximab (RTX) administration as an alternative to traditional cytostatic therapy in adults with SRNS, focusing on its effectiveness and safety profile. Methods: This multicenter, randomized study evaluates the effects of RTX for SRNS treatment, analyzing its clinical outcomes, safety, and efficacy across 52 adults (median age 47, 52% male) over 36 months. Amyloidosis and proliferative diseases were excluded by a kidney biopsy. Results: Complete remission rates improved from 50% to 66.7% by 36 months, with variations based on the morphological types of nephrotic syndrome experienced. The number needed to treat (NNT) for complete remission decreased from indeterminate to 12 by 36 months. RTX was well tolerated, with 17.3% experiencing allergic reactions and 25% developing hypogammaglobulinemia after one year. Severe infusion reactions were managed with omalizumab. Hypogammaglobulinemia and recurrent respiratory infections (21.5%) required additional treatments. Conclusions: RTX shows promise in achieving sustained remission in SRNS, especially in MN and FSGS, with increasing effectiveness over time. While its safety profile is encouraging, extended monitoring is essential for accurate treatment assessments. Further studies are needed to refine RTX protocols and outcomes.