Delayed Therapeutic Response to Oral Corticosteroids and Rituximab Leading to Dialysis Independence in a Patient with Treatment-resistant C3 Glomerulonephritis

A 56-year-old man with nephrotic syndrome was diagnosed with recurrent complement 3 glomerulonephritis (C3GN) without preceding infection. Initial treatment with steroid pulse therapy and oral glucocorticoids failed, and he required hemodialysis due to progressive kidney dysfunction. After rituximab was added, his renal function gradually improved, and dialysis was discontinued. Relapse occurred months later, but combination therapy with steroids and rituximab was effective again. The patient remained dialysis-independent with biannual rituximab infusions. This case illustrates that combining corticosteroids and rituximab may induce remission and preserve the kidney function in relapsing C3GN, even in patients requiring temporary dialysis support.