@article {10563, title = {Outcome of childhood-onset full-house nephropathy.}, journal = {Nephrol Dial Transplant}, volume = {32}, year = {2017}, month = {2017 Jul 01}, pages = {1194-1204}, abstract = {

Background: Patients with full-house nephropathy (FHN) present renal lesions that are indistinguishable from those of lupus nephritis (LN) but lack the systemic features necessary to meet diagnostic criteria for systemic lupus erithematosus (SLE). Some have been reported to develop a delayed SLE with time. The clinical outcome of children having FHN without SLE has never been reported.

Methods: Children with biopsy-proven FHN were selected after excluding SLE cases by the absence of America College of Rheumatology criteria. The proportion of patients with complete (proteinuria <0.5 g/day) or partial remission (proteinuria <=50\% from baseline), relapse (estimated glomerular filtration rate <25\% and/or proteinuria >=50\% from baseline) and progression to Stage III chronic kidney disease (CKD) was described according to age and gender groups with the Kaplan-Meier curve and compared with the Log-rank test. Entity of treatment was summarized by a score at induction (0-6 months) and maintenance (6-18 months). Cox-regression model was performed to test predictors of remission, relapse and progression to CKD.

Results: Among 42 patients (28 pre-pubertal) who met the inclusion criteria, 39 (92.9\%) achieved partial and 32 (76.2\%) complete remission of nephropathy over 2.78 and 7.51 months of follow-up. At 10 years, the probability of progressing to CKD was 4.8\%. Of those achieving remission, 18\% had a renal flare mainly within 4 years after remission. Pre-pubertal males achieved complete remission more frequently than other patients but often relapsed; pre-pubertal females were treated more aggressively. Cox-regression analysis did not find independent predictors of remission or relapse.

Conclusions: The outcome of the patients with FHN we investigated was encouraging. Recurrences are limited to the first 4 years following diagnosis, allowing progressive withdrawal of immunosuppression in patients achieving remission. Evaluation of risk factors for adverse outcome is necessary especially in pre-pubertal children.

}, keywords = {Adolescent, Age of Onset, Child, Disease Progression, Female, Glomerular Filtration Rate, Glomerulonephritis, Humans, Kidney Diseases, Lupus Erythematosus, Systemic, Lupus Nephritis, Male, Proteinuria, Recurrence, Remission Induction, Retrospective Studies, Risk Factors, Survival Rate}, issn = {1460-2385}, doi = {10.1093/ndt/gfw230}, author = {Ruggiero, Barbara and Vivarelli, Marina and Gianviti, Alessandra and Pecoraro, Carmine and Peruzzi, Licia and Benetti, Elisa and Ventura, Giovanna and Pennesi, Marco and Murer, Luisa and Coppo, Rosanna and Emma, Francesco} } @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 = {

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.

}, 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} }