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Open Access 01-08-2015 | Brief Report

Pharmacokinetics of rituximab in a pediatric patient with therapy-resistant nephrotic syndrome

Authors: Clare E. Counsilman, Cornelia M. Jol–van der Zijde, Jasper Stevens, Karlien Cransberg, Robbert G. M. Bredius, Ram N. Sukhai

Published in: Pediatric Nephrology | Issue 8/2015

Abstract

Background

Rituximab (RTX) has recently been introduced as a second-line therapy for nephrotic syndrome in children. Studies show that RTX given during the nephrotic state may be less effective than treatment during a non-nephrotic state, possibly due to loss of RTX in the urine.

Case-Diagnosis/Treatment

We describe a 10-year-old boy with steroid-resistant nephrotic syndrome (SRNS) treated with RTX during a phase of active non-selective proteinuria. The serum half-life of RTX in this patient was less than 1 day compared to 20 days in patients without protein losses. Urinary clearance was at least 25 %, compared to approximately 0 % in control patients. However, RTX loss in the urine, as well as in pleural effusion and ascites, only partly explains the rapid drop in the serum RTX concentration of this patient.

Conclusions

Serum half-life of RTX can be extremely short, partly due to excessive urinary losses in therapy-resistant nephrotic syndrome with non-selective proteinuria, as seen in our patient. These findings may help to explain the poor results of RTX treatment in patients with active proteinuria.

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Title: Pharmacokinetics of rituximab in a pediatric patient with therapy-resistant nephrotic syndrome
Authors: Clare E. Counsilman
Cornelia M. Jol–van der Zijde
Jasper Stevens
Karlien Cransberg
Robbert G. M. Bredius
Ram N. Sukhai
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 8/2015
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-015-3120-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pharmacokinetics of rituximab in a pediatric patient with therapy-resistant nephrotic syndrome

Abstract

Background

Case-Diagnosis/Treatment

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case-Diagnosis/Treatment

Conclusions

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