EFFICACY OF RITUXIMAB ALONE IN PRIMARY PLA2R POSITIVE MEMBRANOUS GLOMERULONEPHRITIS FOLLOWING COVID-19 VACCINE: A CASE REPORT.

E-Poster

https://storage.unitedwebnetwork.com/files/1099/3abf1bf20492b98302115278bdd32dde.pdf

Abstract Title

First Name *

Ahmed

Last Name *

AKL

Co-author 1

Abdulrahman khaled bahatheq akbahathiq@fakeeh.care Dr Soliman Fakeeh Hospital Internal Medicine Jeddah

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Introduction

Rituximab (RTX) has showed efficacy and safety in the treatment of primary membranous nephropathy (PMN). Inhere, We present a case of primary membranous GN that recovered completely with no relapse after Rituximab therapy and did not require steroid therapy.

Methods

A 33-year-old male who had three doses of COVID-19 vaccinations, the last of which was 6 months prior to presentation. Initially presented to the clinic with a history of abdominal pain primarily in the right loin region radiating to the right hypochondrium; general investigations were performed for him and a nephrotic range heavy proteinuria 7 gm per day was discovered; angiotensin receptor blocker was prescribed for him with a temporary decrease in proteinuria as repeated 24-hour urine protein collection was 2mg/day.

Results

A complete blood count revealed a normal hemoglobin level of 15.9 g/dL, as well as a normal white blood cell and platelet count. The liver function tests came back normal. HBV negative and autoimmune negative (C3,C4, ANA, and ANCA C-P). The levels of blood urea nitrogen (BUN) and creatinine were 9.70 mg/dL and 1.34 mg/dL, respectively. Renal biopsy revealed primary membranous glomerulonephritis, for which prednisolone 40mg/day was administered and 4 doses of rituximab 1 g every two weeks were planned; however, prior to starting rituximab, the patient developed eye side-effects from steroids (picture of steroid induced retinopathy), so he began tapering dose and then stopped it. Rituximab 1000 mg was delivered intravenous infusion drip on Days 1, 15, 30, and 45. The patient had no side effects during or after the infusion. Valsartan 80mg was continued regardless of rituximab. After one month, two months, and three months of rituximab treatment, 24-hour urine protein collection dropped to 669 mg/day, 386 mg/day, and 198 mg/day, respectively. After 10 months, the last 24-hour urine protein collection test resulted in only 91 mg/day. In addition to improving proteinuria, the estimated glomerular filtration rate (GFR) was also improved and maintain during the regular follow up for one and half year.

Conclusions

Rituximab alone can effectively induce remission of primary membranous glomerulonephritis and maintain stable renal function with no relapse.

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