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  Sunday, 17 December 2017
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Rituximab is now being offered routinely as first line therapy for idiopathic membranous nephropathy

I have 24 yr old PLA2R positive in biopsy with nephrotic range proteinuria 8 gms his serum creat was already 1.7 mgs /dl, eGFR 45ml/min. His malignancy screen is negative, worried about nephrotoxicity with CNIs , he received two doses of Rituximab and then went into partial remission, he now again has relapse but serum PLA2R disappeared about 2 months back and continues to be undetected , however CD19 count is now 77 from previously less than 5.

Question is
A) if PLA2R is negative but CD19 is high should we dose him with another dose of Rituximab , what is the best monitoring tool here CD19 or PLA2R on Rituximab therapy?
B) In the context of pathognomonic PLA2R being negative in serum, is ponticelli regimen an option at all should nephrotic range proteinuria persist...
Hi Venkat,

I would have to run this question by Dr. Dan Cattran who has greater experience with Ritux in MGN.

My own instinct would be that you could move to alkylating agent therapy if you were unsatisfied with his degree of remission. One thing that did come out of the MENTOR study was that the remissions took longer to achieve and in that study the regimen included a 6-month dose of Ritux for those who did not remit with the day 1 and 15 dose. MENTOR is still unpublished to my knowledge but some of Dan's comment's appeared here:

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