Open AccessRituximab in treatment of anti-GBM antibody glomerulonephritis
Author(s) -
Mayu Uematsu-Uchida,
Tetsuya Ohira,
Shigeki Tomita,
Hiroshi Saito,
Akihiro Tojo,
Toshihiko Ishimitsu
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000017801
Subject(s) - medicine , rituximab , goodpasture's syndrome , rapidly progressive glomerulonephritis , cd20 , autoantibody , immunology , antibody , glomerulonephritis , plasmapheresis , renal biopsy , biopsy , kidney
Rationale: Anti-glomerular basement membrane (GBM) disease is a T cell-mediated disease that has a poor prognosis with conventional therapy. We tested rituximab as a primary therapy to reduce anti-GBM antibody produced by B cells. Patient concerns: A 53-year old woman with complaints of a fever, headache and abdominal discomfort showed renal failure with elevated anti-GBM antibody, and renal biopsy revealed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) 1 deposition along GBM. Diagnoses: The patient's plasma contained autoantibodies against Goodpasture antigen, which is the NC domain of collagen IVα3, and CD4-positive helper T cells were found surrounding crescent glomeruli with the coexistence CD20-positive B cells. Interventions: Rituximab with steroid and plasma exchange. Outcomes: The levels of autoantibody for Goodpasture antigen were reduced, and the patient was able to temporarily withdraw from hemodialysis. Lessons: B cell depletion with rituximab is effective as an initial therapy for anti-GBM disease.