Complete Remission With Rituximab in Relapsed Primary Focal Segmental Glomerulosclerosis Without Use of High‐Dose Glucocorticoids

Focal segmental glomerulosclerosis (FSGS) is a histopathological lesion characterised clinically by nephrotic range proteinuria and frequently progresses to end‐stage kidney disease. Primary FSGS is a complex disease process hypothesised to result from circulating permeability factors resulting in podocyte injury. Glucocorticoids remain the cornerstone of immunosuppressive treatment in the disease; however there is emerging evidence that FSGS may be autoantibody‐mediated, and patients may benefit from targeted B‐cell depleting therapies, such as rituximab. There is minimal evidence evaluating rituximab as an alternative to high‐dose glucocorticoids to achieve remission. Given that relapses and steroid dependence are common in primary FSGS necessitating exposure to long‐term glucocorticoids, steroid‐sparing therapies are needed to reduce glucocorticoid adverse effects. We present the case of a female in her 20s with relapsed primary FSGS with a history of steroid‐induced hypomania. Prior to her relapse she was on maintenance tacrolimus and subsequently achieved rapid clinical and biochemical improvement with the addition of rituximab and low‐dose prednisolone.