nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2020-24-2-52-59nefr-1800Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОпыт применения ритуксимаба при резистентном к терапии фокально-сегментарном гломерулосклерозе у взрослых: серия наблюдений и краткий обзор литературыExperience of application of rituximab with resistant focal-segmental glomerulosclerosis in adults: a series of observations and a brief review of literaturehttps://orcid.org/0000-0003-2128-8560ЧеботареваН. В.ChebotarevaN. V.

Проф. Чеботарева Наталья Викторовна, д-р мед. наук.

Кафедра внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В.Склифосовского

119991, Москва, ул. Трубецкая, д. 8, стр. 2.Тел.: 8-905-543-42-50 

 

Prof. Natalia V. Chebotareva, MD, PhD, DMedSci.

Department of Internal, Occupational Diseases and Rheumatology of the Institute of Clinical Medicine named after N.V. Sklifosovsky.

119991, Moscow, ul. Trubetskaya, d. 8, p. 2.tel. 8-905-543-42-50 

 

natasha_tcheb@mail.ruhttps://orcid.org/0000-0002-8360-7734КучиеваА. М.KuchievaA. M.

Кучиева Агунда Мэлсовна - врач отделения «искусственная почка» Клиники нефрологии, внутренних и профессиональных болезней УКБ №3.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.Тел.: 8-906-044-03-97 

Kuchieva Agunda Melsovna, MD - doctor of the artificial kidney department of the Clinic for Nephrology, Internal and Occupational Diseases, Clinical Hospital No. 3.

119991, Moscow, ul. Trubetskaya, d. 8, p. 2.tel. 8-906-044-03-97 

 

agunda_81@mail.ruhttps://orcid.org/0000-0003-1739-677XЛиО. А.LeeO. A.

Ли Ольга Александровна - врач отделения «искусственная почка» Клиники нефрологии, внутренних и профессиональных болезней УКБ №3.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.Тел.: 8-925-829-16-06 

Li Olga Alexandrovna, MD - doctor of the artificial kidney department of the Clinic for Nephrology, Internal and Occupational Diseases, Clinical Hospital No. 3.

119991, Moscow, ul. Trubetskaya, d. 8, p. 2.tel. 8-925-829-16-06 

shoa1978@bk.ruРощупкинаС. В.RoshchupkinaC. V.

Рощупкина Светлана Васильевна - заведующий отделением нефрологии Клиники нефрологии, внутренних и профессиональных болезней УКБ №3.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.Тел.: 8-916-614-41-81 

Roshchupkina Svetlana Vasilievna, MD - Head of the Department of Nephrology, Clinic for Nephrology, Internal and Occupational Diseases, Clinical Hospital No. 3.

119991, Moscow, ul. Trubetskaya, d. 8, p. 2.tel. 8-916-614-41-81 

roschupkina.sv@yandex.ruhttps://orcid.org/0000-0003-2694-4547ЦаоВ.CaoV.

Цао Веньцзин - аспирант кафедры внутренних, профессиональных болезней и ревматологии, Институт клинической медицины им. Н.В.Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.Тел.: 8-8-916-903-72-38 

Cao Wenjing - Postgraduate student, MD.

Department of Internal, Occupational Diseases and Rheumatology of the Institute of Clinical Medicine named after N.V. Sklifosovsky.

119991, Moscow, ul. Trubetskaya, d. 8, p. 2.tel. 8-8-916-903-72-38 

lrwj101031@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияFirst Moscow State Medical University named after I.M. Sechenov (Sechenov University)Russian Federation2020080220202425259Copyright © Чеботарева Н.В., Кучиева А.М., Ли О.А., Рощупкина С.В., Цао В., 20202020Чеботарева Н.В., Кучиева А.М., Ли О.А., Рощупкина С.В., Цао В.Chebotareva N.V., Kuchieva A.M., Lee O.A., Roshchupkina C.V., Cao V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1800

Стероид-резистентный фокально-сегментарный гломерулосклероз (ФСГС) с нефротическим синдромом (НС) является прогрессирующим заболеванием почек с быстрым развитием терминальной почечной недостаточности (тПН). В последние годы предпринимаются попытки лечения стероид-резистентного ФСГС анти-CD20-моноклональными антителами, ритуксимабом. В настоящее время опубликованы лишь единичные клинические наблюдения и серии, результаты которых противоречивы. ЦЕЛЬЮ нашего исследования было оценить эффективность применения ритуксимаба у больных с резистентным к терапии фокально-сегментарным гломерулосклерозом. ПАЦИЕНТЫ И МЕТОДЫ. В исследование вошли 6 пациентов с морфологически подтвержденным диагнозом ФСГС. Критериями включения были наличие НС, резистентного к терапии высокими дозами кортикостероидов и другим схемам лечения, включая циклоспорин А, такролимус, микофенолата мофетил, циклофосфамид, и исключение вторичной формы заболевания. Пациентам проведен один курс лечения ритуксимабом от 2 до 4 инфузий (суммарная доза составила 1,0–2,0 г). Лабораторные параметры (суточная протеинурия, альбумин и рСКФCKD-EPI) анализировали до назначения ритуксимаба, а также через 6 и 12 мес после завершения лечения. РЕЗУЛЬТАТЫ. В результате терапии у одного пациента достигнута частичная ремиссия ФСГС, стабильная функция почек сохранялась в течение 12 мес наблюдения. У 4 из 6 пациентов наблюдалось дальнейшее прогрессирование с развитием тПН в сроки от 1 до 3 лет, несмотря на уменьшение выраженности НС через 12 мес после введения ритуксимаба. У одного пациента сохранялся НС прежней выраженности в течение 6 мес после введения ритуксимаба, значимой положительной динамики со стороны протеинурии и белков сыворотки крови не отмечено. ЗАКЛЮЧЕНИЕ. Таким образом, мы не выявили значимого эффекта ритуксимаба у больных с резистентным к терапии ФСГС. Однако, учитывая эффективность применения препарата приблизительно у половины больных ФСГС по данным литературы, необходимы дальнейшие проспективные клинические исследования.

Steroid-resistant focal-segmental glomerulosclerosis (FSGS) with nephrotic syndrome (NS) is a progressive kidney disease with the rapid development of end-stage renal failure (ESRD). In recent years, attempts have been made to treat steroidresistant FSHS with anti-CD20 monoclonal antibodies, rituximab. Currently, only a few clinical case reports and series with contradictory results have been published. THE AIM of our study was to evaluate the effect of rituximab in patients with resistant to the therapy focal segmental glomerulosclerosis. MATERIALS AND METHODS: The study included 6 patients with confirmed diagnosis of FSGS. The inclusion criteria were the presence of steroid-resistant NS or to the other treatment regimens, including cyclosporin A, tacrolimus, mycophenolate mofetil, cyclophosphamide, and exclusion criteria were the secondary form of the disease. Patients were treated with one course of rituximab – 2 to 4 infusions (the total dose was 1.0–2.0 g). Laboratory parameters (daily proteinuria, albumin and eGFR CKD-EPI) were analyzed before rituximab, as well as 6 and 12 months after treatment. RESULTS: A partial remission of FSGS was achieved in one patient, stable renal function was maintained for 12 months follow-up. In 4 out of 6 patients, progression of the disease was observed with the development of ESRD in the period from 1 to 3 years, despite a decrease in the severity of NS. In one patient, the NS of the same severity persisted for 6 months after the treatment; no positive dynamics in proteinuria or serum proteins were observed. CONCLUSION: Thus, we did not show a significant effect of rituximab in patients with steroid-resistant FSGS. However, according to the literature the effect of rituximab has been achieved in approximately half of steroid-resistant FSGS cases, therefore further prospective clinical trials are needed.

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The authors declare that there are no conflicts of interest present.