Rituximab Doesn't Help Children With Kidney Disorder

The immune drug rituximab doesn't help to treat children with a particular kidney disorder that is unresponsive to standard treatments, finds a study.

The drug rituximab, an antibody that targets the immune system and is often used to treat immune disorders such as lymphoma and arthritis, has recently emerged as a potential treatment for a childhood kidney disorder known as idiopathic nephrotic syndrome (INS). While the cause of INS is not fully known, it is believed to be an immune disorder. Unfortunately, rituximab does not appear to benefit children who have INS that is resistant to standard treatments, according to a study appearing in an upcoming issue of new study in the Journal of the American Society of Nephrology (JASN).

Quiz on Kidney
The kidneys are two bean-shaped organs, each about the size of a fist, and are located just below the rib cage, one on each side of your spine.

Healthy kidneys filter about half a cup of blood every minute, removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of your bladder. The bladder stores urine. The kidneys, ureters, and bladder are partof the urinary tract.

kidneys remove wastes and extra fluid from your body. Kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals-such as sodium, calcium, phosphorus and potassium-in your blood ().

Anatomy of Urinary System
Animation & slides showing anatomy of urinary system and the role of kidneys in getting rid of the waste products and excess fluid from our body to keep us healthy.

Without this balance, nerves, muscles, and other tissues in the body may not work normally.

Kidneys also make hormones that help

Control your blood pressure
Make red blood cells
Keep your bones strong and healthy

INS has an estimated incidence of two to seven cases per 100,000 children and a prevalence of nearly 16 cases per 100,000. Children with the disease excrete large amounts of protein in their urine and exhibit other signs of kidney damage. Gian Marco Ghiggeri, MD (IRCCS Giannina Gaslini Children Hospital, in Genoa, Italy) and his colleagues recently reported that rituximab can successfully lower protein excretion in children with INS that responds to standard treatments consisting of steroids and immunosuppressants called calcineurin inhibitors. Therefore, rituxmab may allow such patients to discontinue these potentially toxic medications.

A few anecdotal cases and small studies also suggest that rituximab may benefit children with INS that is unresponsive to standard treatments. To test this more rigorously, Ghiggeri and his team conducted the first randomized controlled trial of rituximab in 31 children with INS that did not respond to steroids and calcineurin inhibitors. All children in the study continued taking steroids and calcineurin inhibitors at the doses they took before they enrolled. Half of the patients also received two doses of rituximab.

After three months of treatment, rituximab did not reduce protein excretion in the urine.

By identifying which patients benefit from rituximab and which do not, "our work represents a step forward on the road to treating nephrotic syndrome in children," said Dr. Ghiggeri. However, the negative results of this latest study suggest that researchers and clinicians need a much better understanding of INS to develop effective therapies against cases that are resistant to standard treatment.

Source-Eurekalert

Urology Paediatric Emergencies
The testis can go for a twist inside the sac it is held. This results in loss of blood supply. If left untreated for more than 6 hours the testis loses function.

Rituximab

This medication is a monoclol antibody, prescribed for certain types of cancer such as lymphomas, leukemia, transplant rejection and some autoimmune disorders.