MN Relapse Rituximab Retreatment — ESENeph MCQ

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ModerateGlomerulonephritisMN Relapse Rituximab RetreatmentESENeph

A 45-year-old man with membranous nephropathy on Rituximab achieves complete remission (proteinuria <0.3 g/day) after 12 months. Anti-PLA2R antibodies are undetectable. CD19 B cells have recovered. Eighteen months after treatment, proteinuria rises to 3.5 g/day and anti-PLA2R becomes positive again. What is the most appropriate management?

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Correct answer: A — Retreatment with Rituximab

Relapse of PLA2R-positive MN after Rituximab is characterised by reappearance of anti-PLA2R antibodies followed by rising proteinuria. KDIGO 2021 GN guideline states that the initial therapy can be repeated for relapse. Given the previous excellent response to Rituximab, retreatment with Rituximab (1g at 0 and 2 weeks) is the most appropriate approach. Anti-PLA2R monitoring guides treatment decisions – rising titres may prompt earlier retreatment even before overt clinical relapse.

Reference: KDIGO 2021 – Glomerular Disease Guideline