Objective To observe the effect and safety of rituximab ( RTX ) treatment in pediatric idiopathic membranous nephropathy. Methods The patient was a ten-year-old boy. His condition has not been improved by conventional treatment. He was then treated intravenously with RTX, 500 mg( 375 mg/m2) once a week for four weeks, meanwhile the steroid dosage was reduced to every other day. The level of circulating B and T lymphocyte cells,routine blood and urine tests, liver and renal function were examined before, during and after RTX therapy. Results After RTX therapy, the circulating B cells dropped rapidly fiom 13％ to 0％. One month later, his proteinuria was significantly decreased, and was undetectable after two months. He achieved complete remission and no adverse event was observed. Conclusions The outcome suggests that rituximab may be an effective treatment for idiopathic membranous nephropathy. However, the benefit of long term use in glomerular nephropathy and its safety need further evaluation and prospective randomized controlled trials.%目的 观察利妥昔单抗治疗儿童特发性膜性肾病的疗效及安全性.方法 应用利妥昔单抗前检查血T、B淋巴细胞亚群、血尿常规及肝肾功能.予利妥昔单抗500 mg(375 mg/㎡)静脉输注治疗,每周1次,连用4周.同时激素减量至隔日口服.结果 应用利妥昔单抗治疗后血总B淋巴细胞由13%降为0%,1个月后患儿的尿蛋白显著下降,2个月后尿蛋白转阴、肾病缓解.同时该患儿对利妥昔单抗治疗耐受性好,未出现相关的不良反应.结论 利妥昔单抗治疗儿童特发性膜性肾病有一定疗效,但其治疗肾病的确定性及安全性仍需进一步临床随机试验加以证实.
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