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  Thursday, 17 December 2015
  3 Replies
  9.3K Visits
70 y/o male with acute onset of severe nephrotic syndrome and AKI. clinically manifested with severe edema developed within a week period and serum albumin of 1.9gm/dl.
Kidney biopsy showed MCD.
Patient has chronic fungal endophthalmitis maintined on fluconazole.
Any suggestions on treatment protocol? Trying to avoid steroids or any T cell acting drugs to avoid flare up of the fungus.
Would you consider Rituximab?

Rituximab in MCD is not well established and has only really been effective in steroid dependant, not steroid resistant disease. Cyclphosphamide can be used in steroid-free regimens but this would not satisfy your criteria to avoid drugs with lymphocyte depletion. MMF has been used in MCD with some success but again, studies are limited. Cyclosporine can be used with low-dose prednisone and so while not steroid-free, might achieve the steroid minimization you are looking for.

Dr. Jordan Weinstein
8 years ago
Thanks for the valuable input.
Would CNI increase risk of fungal infection flare up in this patient?
I suppose any immunosuppression would increase the risk of fungal disease, especially during the 'induction' period when dosages are typically higher. By I would think that low-dose prednisone and CNI would be lower risk than other, more intensive regimens.

Dr. Jordan Weinstein
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