Abstract

EFFICACY AND SAFETY OF RITUXIMAB IN PAEDIATRIC NEPHROTIC SYNDROME: A REVIEW ARTICLE

Ameen Labba N.*, Swaliha Sulfi*, Shifana S.*, Dr. Sini S. J.

ABSTRACT

Childhood-onset frequently relapsing nephrotic syndrome (FRNS) and steroid-dependent nephrotic syndrome (SDNS) are associated with repeated relapses, prolonged corticosteroid exposure, and significant treatment-related adverse effects. Conventional immunosuppressive therapies such as cyclophosphamide, ciclosporin, tacrolimus, and mycophenolate mofetil may reduce relapse frequency; however, many patients continue to experience disease recurrence and drug toxicity. Rituximab, a monoclonal anti-CD20 antibody causing B-cell depletion, has emerged as a promising therapeutic option for refractory nephrotic syndrome. This review summarizes the efficacy, safety, and clinical outcomes of rituximab therapy in childhood-onset complicated FRNS and SDNS, with particular emphasis on evidence from randomized controlled trials and observational studies. The landmark multicentre, double-blind, placebo-controlled trial by Kazu moto Iijima demonstrated that rituximab significantly prolonged relapse-free survival, reduced relapse rates, and lowered cumulative steroid exposure compared with placebo. The drug was generally well tolerated, although infections, infusion reactions, neutropenia, and lymphocytopenia were reported. Current evidence suggests that rituximab provides an effective steroid-sparing strategy and improves disease control in children with difficult-to-treat nephrotic syndrome. Nevertheless, concerns remain regarding long-term safety, relapse after B-cell recovery, optimal dosing schedules, and monitoring strategies. Further long-term studies are required to establish standardized treatment protocols and evaluate sustained remission, growth outcomes, and late adverse effects. Rituximab represents an important advancement in the management of complicated paediatric nephrotic syndrome and may significantly improve quality of life in affected children.

Keywords: * Rituximab * Nephrotic Syndrome * Frequently Relapsing Nephrotic Syndrome (FRNS) * Steroid-Dependent Nephrotic Syndrome (SDNS) * Paediatric Nephrology * B-cell Depletion Therapy * Immunosuppressive Therapy * Steroid-Sparing Therapy * Relapse-Free Surviva