Treatment with rituximab and hydroxychloroquine in a patient with membranous nephropathy and diabetic nephropathy: A case report

Xiaoyuan Ning, Na Xu, Mengke Chen, Jiayun Xu
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引用次数: 1

Abstract

Abstract Nephrotic syndrome (NS), which includes primary and secondary types, is one of the causes of end-stage kidney disease. Common causes in adults include diabetic nephropathy (DN), membranous nephropathy (MN), and focal segmental glomerulosclerosis. About 30%–40% of diabetics can develop into DN. The incidence of primary nephrotic syndrome in diabetic patients was not significantly different from that in the general population. Herein we present a windfall from the treatment of rituximab combined with hydroxychloroquine in a patient with primary MN and DN. A 51-year-old Chinese man, diagnosed with type 2 diabetes mellitus (T2DM) 12 years ago, was admitted to the hospital due to edema of bilateral lower limbs and severe proteinuria. Serology showed the obvious elevation of the anti-phospholipase A2 receptor (anti-PLA2R) level and renal biopsy showed MN concomitant with DN. After low dosage of prednisone and standard dosage of rituximab, the patient’s proteinuria decreased; however, the effect was unsatisfactory and proteinuria was elevated again in 8 months. Thus, treatment with rituximab and hydroxychloroquine was initiated, which resulted in proteinuria diminishing significantly and albumin returning to normal level. Therefore, even complicated with DN, patients diagnosed with primary MN still have a promising remission after being treated with rituximab and hydroxychloroquine.
利妥昔单抗联合羟氯喹治疗膜性肾病合并糖尿病肾病1例
摘要肾病综合征(Nephrotic syndrome, NS)是终末期肾病的病因之一,分为原发性和继发性肾病。成人常见的病因包括糖尿病肾病(DN)、膜性肾病(MN)和局灶节段性肾小球硬化。约30%-40%的糖尿病患者可发展为DN。糖尿病患者原发性肾病综合征的发生率与普通人群无显著差异。在此,我们报告了利妥昔单抗联合羟氯喹治疗原发性MN和DN患者的意外收获。一名51岁的中国男性,12年前诊断为2型糖尿病(T2DM),因双侧下肢水肿和严重蛋白尿而入院。血清学显示抗磷脂酶A2受体(anti-PLA2R)水平明显升高,肾活检显示MN伴DN。低剂量泼尼松加标准剂量利妥昔单抗后,患者蛋白尿下降;然而,效果不理想,8个月后蛋白尿再次升高。因此,开始使用利妥昔单抗和羟氯喹治疗,导致蛋白尿显著减少,白蛋白恢复到正常水平。因此,即使合并DN,诊断为原发性MN的患者在接受利妥昔单抗和羟氯喹治疗后仍有希望缓解。
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