Infection prophylaxis following anti-CD20 monoclonal antibodies in childhood kidney diseases

Anti-CD20 monoclonal antibodies (mAbs), which act as B-cell-depleting therapies, are now regarded as important treatments for a range of paediatric kidney diseases. Despite their effectiveness in achieving B-cell depletion and consequent disease remission, concerns remain regarding their side effect profile. These include infusion reactions, hypogammaglobulinaemia, and neutropenia, as well as infections. At present, the evidence supporting preventive measures such as intravenous immunoglobulin (IVIG) replacement and antibiotic prophylaxis remains inconclusive. In this review, we summarise the existing data on infection-related risks following anti-CD20 therapy and propose practical strategies to mitigate infection risk tailored to this group of children.