Update on the role of rituximab in kidney diseases and transplant.

INTRODUCTION: Pathological antibody production by B lymphocytes is characteristic of numerous primary and secondary glomerular diseases of the kidney. Specific and less toxic therapies that target antibody-producing B cells are therefore needed. Based on its property of selectively depleting CD20(+) B cells, rituximab is a therapeutic option for antibody-mediated kidney diseases and adds to the existing drug armamentarium for the treatment of a number of these disorders. AREAS COVERED: This article reviews the current use of rituximab in renal disease and transplantation, and includes discussion of the drug's potential role in conditions where traditional treatment has failed. A literature search using PubMed data base was undertaken using search words rituximab and kidney transplantation, glomerulonephritis, antibody production etc. EXPERT OPINION: Rituximab could be a beneficial drug in certain renal diseases and for complications related to kidney transplantation where conventional treatment has not been successful.

Relapsing or refractory idiopathic thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: the role of rituximab.

Idiopathic thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is a rare disease responsive to treatment with plasma exchange (PE) but with a high percentage of relapse or refractory patients. A severe deficiency of ADAMTS-13 (<5% of normal activity), congenital or caused by an autoantibody, may be specific for TTP and it has been proposed that severe ADAMTS-13 deficiency now defines TTP. B cells play a key role in both the development and the perpetuation of autoimmunity, suggesting that B-cell depletion could be a valuable treatment approach for patients with idiopathic TTP-HUS. This review of the literature focuses on the role of rituximab, a chimeric monoclonal antibody directed against CD20 antigen expressed by B lymphocytes, in patients with relapsing or refractory TTP-HUS with or without ADAMTS-13 deficiency, suggesting that rituximab may produce clinical remission in a significant proportion of patients. Rituximab therapy reduces plasma requirement and avoids complications related to salvage-immunosuppressive therapy. In conclusion, rituximab provides an effective, well-tolerated, and safe treatment option for patients with idiopathic TTP-HUS, thus giving an alternative approach to the current treatment based on PE.