Treatment of nephrotic syndrome with anti-CD20 therapies in pregnancy: a case series and review of the literature

Abstract

Membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) are autoimmune kidney diseases and the most common causes of nephrotic syndrome. Anti-CD20 monoclonal antibodies are now recommended as first-line therapy for MN. Anti-CD20 monoclonal antibodies are also effective in steroid-dependent or frequently relapsing nephrotic syndrome associated with MCD or FSGS. Many women eligible for these treatments are of childbearing age. The impact of anti-CD20 therapies on pregnancy and fetal outcomes remains uncertain, particularly in glomerular diseases. We describe three cases of patients with glomerular disease treated with anti-CD20 therapies in the context of pregnancy and review the literature.

Keywords: Pregnancy; auto-immunity; nephrotic syndrome; obinutuzumab; rituximab.

Figure 1.

Trends in urine protein-creatinine ratio, serum albumin, estimated glomerular filtration rate, CD19⁺ count and anti-PLA2R antibody titer before, during and after pregnancy in the three cases. The pink dotted line represents the period of pregnancy. M0 indicates the beginning of pregnancy. For case 1, no biological data are available before pregnancy or at M0. The green star means that the CD19⁺ count is not available at this time.CD19⁺ cell count laboratory standards: 90–390/mm³. The anti-PLA2R antibody titer was determined by the ELISA test developed by EUROIMMUN (Medizinische Labordiagnostika AG, Lübeck, Germany). Abbreviations: Ab, antibody; eGFR, estimated glomerular filtration rate (CKD-EPI formula); OBI, obinutuzumab; PLA2R, phospholipase A2 receptor; RTX, rituximab; UPCR, urine protein-creatinine ratio.