The 493th case: recurrent edema of bilateral lower extremeties
10.3760/cma.j.cn112138-20210603-00393
- VernacularTitle:第493例——反复双下肢水肿
- Author:
Huaiya XIE
1
;
Gang CHEN
;
Hang LI
;
Xuemei LI
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院内科，北京 100730
- Keywords:
Refractory membranous nephropathy;
Rituximab;
Anti-M type Phospholipase-A2-receptor antibody
- From:
Chinese Journal of Internal Medicine
2022;61(3):355-358
- CountryChina
- Language:Chinese
-
Abstract:
A 43-year-old male patient with onset of edema caused by nephrotic proteinuria and low titer of anti-M type phospholipase-A 2-receptor (PLA 2R) antibody was diagnosed as idiopathic membranous nephropathy by renal biopsy. Administrated with prednisone 40 mg once a day and cyclosporine 100 mg twice a day as front-line regimen, the patient relapsed after transient partial remission. When treatment was combined with cyclophosphamide 100 mg once a day, the 24-hour total urine protein and titer of anti-PLA 2R antibody were even elevated. Therefore, the patient received rituximab 1 g intravenously in April 2019, October 2019 and October 2020 respectively. CD19 positive B lymphocytes in peripheral blood were eliminated from 71/μl to zero. Immunosuppressants and corticosteroids were withdrawn successively. On the last follow-up in November 2020, the anti-PLA 2R antibody was negative, and the 24-hour total urine protein and serum albumin was 4.4 g and 34 g/L, respectively. This case suggested the potential efficacy of rituximab for refractory membranous nephropathy. Further studies should explore whether the titer of anti-PLA 2R antibody indicates the dose of rituximab.
