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Objective: To determine the efficacy of Rituximab (RTX) in refractory steroid dependent and steroid resistant childhood nephrotic syndrome. Study Design: Prospective single-arm interventional study Place and Duration: Department of Pediatric Nephrology at the Children’s Hospital & the Institute of Child Health, Multan, Pakistan from June 2019 to November 2020. Materials and Methods: Total 26 patients age 3.25-11.25 years of either gender were included; 17 children with refractory steroid dependent nephrotic syndrome (SDNS) and 09 children with refractory steroid resistant nephrotic syndrome (SRNS). After induction of remission, refractory SDNS patients were given two pulses of intravenous RTX two weeks apart. The children with SRNS were given 4 weekly pulses of RTX with concomitant prednisolone; 12 weeks at they were categorized as either complete responder, partial responder, or non-responder. All the patients were followed up to 18 months to look for long-term response and any complications. Results: Mean age of the patients was 6.91 + 2.40 years, and males constituted 61.54% of the study participants. All 17 SDNS patients remained relapse free for 10 months to more than 12 months following RTX treatment. On the other hand, only one patient (11.11%), out of total 09 patients with refractory SRNS, achieved complete remission, and 03 (33.33%) patients went into partial remission, while 05 (55.55%) were resistant to RTX also. Safety profile of RTX was excellent. Conclusion: Rituximab is a safe and effective option for difficult-to-treat SDNS children.

MUHAMMAD IMRAN, HASHIM RAZA, KHURAM RASHID, Shahid Ishaq, Mudassar Adnan. (2021) A Single Center Experience of Rituximab in Treating Refractory Steroid Dependent and Steroid Resistant Childhood Nephrotic Syndrome, Pakistan Pediatric Journal, Volume 45, Issue 2.
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