Objective:
To investigate the
efficacy and
safety of individualized
rituximab rescue
therapy for active
lupus nephritis with
acute kidney injury (AKI).
Methods:
The clinical data of
lupus nephritis patients with AKI treated with
rituximab at the
Kidney Disease Center of the First Affiliated
Hospital of Zhejiang
University School of
Medicine from April 2017 to June 2020 were collected, and the renal remission rate and adverse events after
rituximab treatment were analyzed retrospectively. The Kaplan-Meier
method was used to calculate the
cumulative incidence of
patients' remission.
Results:
There were 13
patients enrolled, including 8
females, and
aged (35.23±15.92) years old. The urinary
protein/
creatinine ratio was (5.22±1.57) g/g before
rituximab treatment. Four
patients were on
dialysis at admission, and 9
patients without
dialysis had
serum creatinine of (223.22±85.73) μmol/L. Eight
patients were confirmed as proliferative
lupus nephritis by renal
biopsies, including 7 cases with crescent formation and 1 case with
thrombotic microangiopathy (TMA), and the other 5 cases without renal
biopsies were clinically diagnosed as TMA. The
dose of
rituximab was (815±516) mg (200-2 100 mg), and all the
patients reached the
state of peripheral
blood B
cells clearance (CD19 + B
cell count was<5/μl). After the first
treatment of
rituximab, the median
time to B-
cell clearance was 21(15, 35) days, and 8
patients reached B-
cell depletion (CD19 + B
cell count was 0). The remission rate was 12/13 (two cases reached complete remission, and 10 cases reached partial remission). Three cases stopped
dialysis, and 1 case (with glomerulosclerosis of 52.94%) entered maintaining
dialysis. The
relapse times in the
maintenance remission period of 7
patients with refractory
lupus nephritis declined significantly from (1.57±0.53) times in a median
history of 60(20, 109) months to (0.43±0.79) times in a median
history of 18(10, 23) months after the use of
rituximab ( P=0.015). After using
rituximab, the
incidence of
infection was 7/13. The median
time from the use of
rituximab to
infection was 26(4, 44) days. Pulmonary
infection (5/13) was the most common type and all infected
patients recovered after anti-
infection treatment.
Conclusions:
Rituximab can be used in the
treatment of active
lupus nephritis with AKI, especially in
patients with crescent formation and TMA, but the
infection should be paid close
attention to and prevented.