Efficacy and safety of low-dose rituximab in treatment of pediatric nephrotic syndrome: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVES@#To study the efficacy and safety of repeated application of rituximab (RTX) at a low dose (200 mg/m2) versus the recommended dose (375 mg/m2) for remission maintenance in frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS).@*METHODS@#A randomized controlled trial was conducted for 29 children with FRNS/SDNS who received systemic treatment in the Department of Nephrology, Anhui Provincial Children's Hospital, from September 2020 to December 2021. These children were divided into a recommended dose group (n=14) and a low dose group (n=15) using a random number table. The two groups were compared in terms of general characteristics, changes in CD19 expression after RTX treatment, number of relapses, glucocorticoid dose, adverse reactions of RTX, and hospital costs.@*RESULTS@#After RTX treatment, both the low dose group and the recommended dose group achieved B-lymphocyte depletion and had significant reductions in the number of relapses and glucocorticoid dose (P<0.05). The low dose group had a comparable clinical effect to the recommended dose group after RTX treatment (P>0.05), and the low dose group had a significant reduction in hospital costs for the second, third, and fourth times of hospitalization (P<0.05). There were no serious adverse reactions in either group during RTX treatment and late follow-up, and there was no significant difference in adverse reactions between the two groups (P>0.05).@*CONCLUSIONS@#Repeated RTX treatment at a low dose has comparable clinical efficacy and safety to that at the recommended dose and can significantly reduce the number of FRNS/SDNS relapses and the amount of glucocorticoids used, with little adverse effect throughout the treatment cycle. Therefore, it holds promise for clinical application.

Effect of Serum IgE Level between Frequent Relapse and Infrequent Relapse Nephrotic Syndrome in Children

Objective: In this study our main objective is to evaluate effectof serum IgE level between frequent relapse and infrequentrelapse nephrotic syndrome in children.Methodology: This Cross-sectional comparative studyconducted at the Department of Paediatric Nephrology,Bangabandhu Sheikh Mujib Medical University (BSMMU) andDepartment of Paediatrics, Dhaka Medical College Hospital,Dhaka from February 1, 2010 to October 1, 2010. During thestudy, 60 children were included in the study according tojudgmental or purposive sampling method and they weregrouped as follows: Group A (n = 30): Frequent RelapseNephrotic Syndrome (FRNS), Group B (n= 30): InfrequentRelapse Nephrotic Syndrome (IFRNS).Results: During the study, majority (60%) were of age groupA, 2-5. On the other hand in group-B, majority (66.8%) were ofage groups 2-5 years followed by (16.7%) were of age group 6-9 years and 5 (16.6%) were of age group 10-15 years. Duringrelapse of the disease serum immunoglobulin E (IgE) level wasapproximately 3.5 times higher in group A than that of group Bwhich was 1573.60IU/ml (SD ±197.01) vs. 438.46IU/ml (SD±51.6).Conclusion: From our study we can conclude that, that serumIgE level in frequent relapse nephrotic syndrome wassignificantly higher (P < 0.001) in comparison to infrequentrelapse nephrotic syndrome in children during both relapse andremission irrespective of history of atopy. So serum IgE levelmight have an influence for the occurrence of relapse inchildhood idiopathic nephrotic syndrome

Analysis of frequent relapses related factors of primary nephrotic syndrome in children / 国际儿科学杂志

Objective To explore the influencing factors of frequent relapse primary nephritic syndrome (PNS) in children according to the statistical analysis of their clinical data and laboratory examinations. Method We collected in-hospital and out-patient medical records of children who were diagnosed PNS from Jan. 2007 to Feb. 2010 and whole clinical data were analyzed. Results In 245 cases of children with steroid sensitine nephrotic syndrome, non-frequent replapse (NFR) accounted for 82.4% and frequent relapse (FR) accounted for 17.6%. In univariate analysis, period of first relapse between initial treatment remission within 3 months , level of serum total protein and cholesterol and IgE at onset had statistical significance in FR children and NFR children, which were significant predictors of FR. The logistic regression analysis revealed that the first relapse after initial treatment remission within 3 months and increasing of serum IgE level (more than 358 IU/ml)were risk factors of FR. Among frequent relapses factors, infection, especially upper respiratory tract infection was the first (65. 1%). The relapse with motivation mainly in January to March, accounted for 30. 4%. Conclusion FR had a proportion of 17. 6% in children with PNS under regular glucocorticoid treatment. It showed seasonality feature that relapse. peak in winter and spring. Level of the serum total protein less than 40g/L and cholesterol more than 10mmol/L at onset can be predictive index of FR. Infections are the main motivation of relapse, but the relapse by irregular treatment and specific constitutions should be pay more attentions too.