Minimal change disease with maximum immunosuppression: successful treatment of steroid-dependent minimal change disease with rituximab.

Minimal change disease (MCD) is usually steroid sensitive, although in case of steroid dependent and multiple relapses we can struggle with different immunosuppressive agents, sometimes with no response. Rituximab has been emerging as an alternative therapeutic option.We describe a case of a young patient with MCD that had frequent relapses and steroid dependency, with no response to several immunosuppressive agents during 15 years of disease. He was kept under high-dose steroids and ciclosporin. He started treatment with rituximab (two administrations of 1 g 2 weeks apart, repeating after 6 months). The steroids dose was gradually reduced and the ciclosporin was stopped. During the entire 2 years follow-up period, he remained in remission and had no adverse events.This remarkable outcome reinforces the option of using rituximab in difficult cases, allowing the reduction of steroid burden and its adverse effects, which is of extreme importance, especially in young patients.

Quality of life in patients with minimal change nephrotic syndrome.

AIM: The goal of the study was to investigate quality of life (QOL) in adult patients with minimal change nephrotic syndrome (MCNS) and to test the relationship of QOL with the level of self-care. MATERIALS AND METHODS: We distributed two questionnaires to 30 outpatients with MCNS. The MOS 36-item Short Form Health Survey (SF-36v2) was used to examine health-related QOL in comparison with normative data from the general Japanese population and a population with two chronic diseases. SF-36v2 consists of 36 questions classified into 8 subscales. We also used the Self-Care Behavior Scale for patients with chronic kidney disease (CKD), which consists of 31 questions with 4 subscales. RESULTS: The SF-36v2 social functioning subscale was most impaired and bodily pain was least affected in patients with MCNS. The self-care subscales of information/communication and positive behavior had positive correlations with the QOL subscales of mental health (P<0.05) and vitality (P<0.05). The correlation between social functioning and information/communication was close to significant (P=0.051). CONCLUSION: In MCNS, social functioning was particularly impaired. Our results suggest that better self-care can have a positive impact on QOL in patients with MCNS.