Rituximab in Patients with the Steroid-Resistant Nephrotic Syndrome

To the Editor: The treatment of patients with the steroid-resistant nephrotic syndrome (SRNS) is challenging. Persistent proteinuria and hypoalbuminemia result in serious complications and progressive kidney disease. Intensive treatment regimens show varying results in inducing remission but are associated with adverse effects. On the basis of suggestions that B lymphocytes are crucial in the pathogenesis of the nephrotic syndrome,1 we examined the efficacy of treatment with rituximab, a monoclonal antibody against CD20 antigen, in patients with SRNS that was resistant to treatment with high-dose corticosteroids, alkylating agents, and calcineurin inhibitors. Five patients (three with initial resistance and two with late . . .