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Rituximab treatment in children with IgA vasculitis nephritis: a case series of an international cohort
  1. Katharina Rohner1,2,
  2. Matko Marlais3,4,
  3. Alaa Ali5,
  4. Stephane Decramer6,
  5. Madeleine Didsbury7,
  6. Thomas A Forbes7,8,
  7. Mikael Koskela9,
  8. Eda Didem Kurt Şükür10,
  9. Claudio La Scola11,
  10. Mercedes Lopez12,
  11. Nabila Moussaoui6,
  12. Ana Cecilia Navarro13,
  13. Matti Nuutinen14,15,
  14. Michiel Oosterveld16,
  15. Andrea Pasini11,
  16. Joris Roelofs17,
  17. Kjell Tullus3
  1. 1Department of Pediatric Nephrology, University Children's Hospital Zürich, Zürich, Switzerland
  2. 2Department of Pediatric Nephrology, Children's Hospital St. Gallen, St Gallen, Switzerland
  3. 3Paediatric Nephrology Department, Great Ormond Street Hospital for Children, London, UK
  4. 4UCL Great Ormond Street Institute for Child Health, University College London, London, UK
  5. 5Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle, UK
  6. 6Paediatric Nephrology Centre, CHU Purpan, Centre de Référence du Sud-Ouest des Maladies Rénales Rares SORARE, Filière ORKiD, Hopital des Enfants, Toulouse, France
  7. 7Department of Nephrology, Royal Children's Hospital, Melbourne, Victoria, Australia
  8. 8Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  9. 9Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  10. 10Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
  11. 11Nephrology and Dialysis Unit, Department of Pediatrics, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
  12. 12Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
  13. 13Instituto Nacional de Pediatria in Mexico City, Mexico City, Mexico
  14. 14Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
  15. 15PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu, Oulu, Finland
  16. 16Emma Childrens' Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
  17. 17Department of Pathology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Katharina Rohner; katharina.rohner{at}kispi.uzh.ch

https://doi.org/10.1136/archdischild-2024-327098

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    Treatment recommendations for IgA vasculitis (IgAV)-associated nephritis (IgAVN) are mainly based on expert opinion resulting in variation. A recent review describes B-cell depletion as a potential treatment for IgAVN.1 Successful treatment of IgAVN with rituximab has been reported in adult patients.2 To our knowledge, only one case series of three children has reported rituximab treatment for IgAV, and two of them had IgAVN.3

    We recently reported on a large international cohort of 1148 children with biopsy-proven IgAVN.4 For this study, we retrospectively analysed all patients who received rituximab.

    Eleven patients from nine international centres received rituximab at a median time of 1.5 months (IQR 0.6–2.1) after the onset of IgAV. The median estimated glomerular filtration rate (eGFR) at biopsy was 119.3 mL/min/1.73 m2 (IQR 82.3–147.7). Protein–creatinine ratio (UPUC) >200 mg/mmol was present in nine patients. Eight patients had hypoalbuminaemia (<35 g/L). At the start of rituximab, median eGFR was 88.9 mL/min/1.73 m2 (IQR 58.9–128.5) and median UPUC 837.0 mg/mmol (IQR 421–1420). Patient data including additional treatments are summarised in table 1.

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    Table 1

    3–6 months after rituximab treatment, the median eGFR was …

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    Footnotes

    • X @kidneytom, @anacecinefroped

    • Contributors KR, MM and KT designed the study, collected and cleaned the data, conducted and reviewed statistical analyses, wrote the manuscript and reviewed and revised the final manuscript. KR and KT are guarantors of the published data. AA, SD, MD, TAF, MK, EDKS, CLS, NM, ACN, MN, MO, AP and JR reviewed patients for inclusion, collected data and reviewed and revised the final manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.