@article {3497,
	title = {Rituximab in steroid-dependent or frequently relapsing idiopathic nephrotic syndrome.},
	journal = {J Am Soc Nephrol},
	volume = {25},
	year = {2014},
	month = {2014 Apr},
	pages = {850-63},
	abstract = {<p>The outcome of steroid-dependent or frequently relapsing nephrotic syndrome of minimal change disease (MCD), mesangial proliferative GN (MesGN), or FSGS may be poor and with major treatment toxicity. This academic, multicenter, off-on trial (ClinicalTrials.gov $\#$NCT00981838) primarily evaluated the effects of rituximab therapy followed by immunosuppression withdrawal on disease recurrence in 10 children and 20 adults with MCD/MesGN (n=22) or FSGS who had suffered >=2 recurrences over the previous year and were in steroid-induced remission for >=1 month. Participants received one dose (n=28) or two doses of rituximab (375 mg/m(2) intravenously). At 1 year, all patients were in remission: 18 were treatment-free and 15 never relapsed. Compared with the year before rituximab treatment, total relapses decreased from 88 to 22 and the per-patient median number of relapses decreased from 2.5 (interquartile range [IQR], 2-4) to 0.5 (IQR, 0-1; P<0.001) during 1 year of follow-up. Reduction was significant across subgroups (children, adults, MCD/MesGN, and FSGS; P<0.01). After rituximab, the per-patient steroid maintenance median dose decreased from 0.27 mg/kg (IQR, 0.19-0.60) to 0 mg/kg (IQR, 0-0.23) (P<0.001), and the median cumulative dose to achieve relapse remission decreased from 19.5 mg/kg (IQR, 13.0-29.2) to 0.5 mg/kg (IQR, 0-9.4) (P<0.001). Furthermore, the mean estimated GFR increased from 111.3{\textpm}25.7 to 121.8{\textpm}29.2 ml/min per 1.73 m(2) (P=0.01), with the largest increases in children and in FSGS subgroups. The mean height z score slope stabilized in children (P<0.01). Treatment was well tolerated. Rituximab effectively and safely prevented recurrences and reduced the need for immunosuppression in steroid-dependent or frequently relapsing nephrotic syndrome, and halted disease-associated growth deficit in children.</p>},
	keywords = {Adolescent, Adrenal Cortex Hormones, Adult, Antibodies, Monoclonal, Murine-Derived, Child, Female, Glomerulonephritis, Membranoproliferative, Glomerulosclerosis, Focal Segmental, Humans, Male, Middle Aged, Nephrosis, Lipoid, Nephrotic Syndrome, Recurrence, Rituximab},
	issn = {1533-3450},
	doi = {10.1681/ASN.2013030251},
	author = {Ruggenenti, Piero and Ruggiero, Barbara and Cravedi, Paolo and Vivarelli, Marina and Massella, Laura and Maras{\`a}, Maddalena and Chianca, Antonietta and Rubis, Nadia and Ene-Iordache, Bogdan and Rudnicki, Michael and Pollastro, Rosa Maria and Capasso, Giovambattista and Pisani, Antonio and Pennesi, Marco and Emma, Francesco and Remuzzi, Giuseppe}
}
