Steroid Retrial After Rituximab and Mycophenolate Mofetil in Pediatric Refractory Nephrotic Syndrome

Amrit Kirpalani, Guido Filler, Joanne Grimmer, Vladimir Belostosky, Steven Arora, Ajay P. Sharma


Steroid-resistant nephrotic syndrome (SRNS) is a challenging condition. In pediatric SRNS, cyclosporine is the first-line treatment choice, with approximately 60% success rate. In cyclosporine-resistant disease, treatment modalities such as cyclophosphamide, mycophenolate mofetil (MMF), tacrolimus, vincristine, galactose, plasmapheresis and rituximab have been tried with variable success. In this paper, we report a patient with SRNS who remained resistant to all the above stated medications except a moderate response to rituximab. After rituximab, MMF re-initiation did not induce further improvement. Prednisone retrial thereafter induced a prompt remission. The significance of this finding in context with current literature has been discussed.

World J Nephrol Urol. 2016;5(2):33-36


Focal segmental glomerulosclerosis; Refractory nephrotic syndrome; Rituximab; Mycophenolate mofetil; Steroid retrial

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