A recent article in CJASN 2010 talks about the role of anti CD20 agent in treatment of recurrent membranous GN. The article is a retrospective review and more of a case series of 4 patients that responded to rituximab for recurrent idiopathic GN.
Its a small group of patients as most of them that they had responded well to just anti proteinuric agents.
This is not unusual to see a small number of patients with recurrence of such diseases as some of the drugs we are using for rejection are also controlling the autoimmune disease. But then why do some patients get it and some don't get recurrence. Perhaps it might have to do with compliance, the nature of their membranous disease or their age perhaps. When they compared the patients with recurrent membranous to ones without recurrence, nothing was significant( nor progression to ESRD, age, BUN, GFR, TP, proteinuria amount) except for albumin.
Interestingly, 3/4 patients with recurrent membranous that got rituxan also were on steroid sparing protocol.
Also, interesting to note, 10/15 that were recurrent were LRRTx and only 60% of them received induction treatment. I think even though those didn't meet significance,( perhaps due to small numbers), matter a lot.
Related relatives, steroid sparing and no induction could be possible risk factors for recurrence in any autoimmune disease, perhaps!
Something to ponder on
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