2026-07-08 | Obinutuzumab as a primary anti-CD20 agent in pediatric frequently relapsing and steroid-dependent nephrotic syndrome.
Idiopathic nephrotic syndrome (INS) is the leading glomerular disease in children, often responding well to steroids. However, frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) require the introduction of steroid-sparing agents to mitigate steroid toxicity. This retrospective, pilot study including 6 patients with FRNS or SDNS assessed the efficacy and safety of obinutuzumab as a first line of anti-CD20 therapy. Using one dose of obinutuzumab, complete remission was achieved in all 6 patients within 11 months. Remission rate was 100% up to 12 months post-injection, and 80% at both 24 and 56 months. Infusion-related reactions occurred in 83% of the patients, primarily mild and transient; one patient required immunoglobulin supplementation but no severe infections were noted. These preliminary results suggest that obinutuzumab is a promising first-line anti-CD20 therapy for FRNS and SDNS in children, offering sustained remission with a good safety profile.
Open article ↗
2026-07-06 | Use of rituximab and mycophenolate in cortic-dependent nephrotic syndrome in pediatrics
introduction: Idiopathic nephrotic syndrome (INS) in children may present frequent relapses or steroid dependence, with a risk of corticosteroid toxicity.In this context, rituximab (RTX) and mycophenolate mofetil (MMF) were used as alternative therapeutic options.Materials and methods: A prospective observational cohort study was conducted in a pediatric nephrology unit in the Autonomous City of Buenos Aires, including 12 patients with steroid-dependent nephrotic syndrome (SDNS) who received sequential treatment with RTX and MMF.results: Of the 12 patients treated with RTX, 4 achieved sustained remission.The remaining 8 had fewer than 2 relapses per year but required potentially toxic steroid doses; therefore, after a mean period of 13 months post-RTX, MMF was added.All patients remained in remission until the end of the study.The cumulative steroid dose (CSD) pre-RTX was 5335 mg/m 2 and post-RTX was 2024 mg/m 2 (p = 0.001).Finally, the mean CSD with MMF was 1378 mg/m 2 (Wilcoxon test: T = 3.5, p = 0.005).In the 10 patients who experienced at least one relapse, the mean CD20 lymphocyte count one month after RTX was 3.7 cells/mm 3 , and at relapse it was 26 cells/mm 3 (CD20-proteinuria correlation coefficient: 0.54).Observed adverse effects were minimal and reversible.conclusion: Sequential therapy with RTX and MMF may be an option for patients with primary steroid-dependent nephrotic syndrome.
Open article ↗
2026-07-06 | Expression of PD-1 on T cells and its predictive value for steroid resistance in children with idiopathic nephrotic syndrome.
Programmed cell death protein 1 (PD-1) plays a pivotal role in regulating T-cell responses. Its expression profile and clinical significance in pediatric idiopathic nephrotic syndrome (INS), particularly in steroid-resistant nephrotic syndrome (SRNS), remain unclear. PD-1 expression on CD3⁺, CD4⁺, and CD8⁺T cells was quantified by flow cytometry in 65 treatment-naive children with idiopathic nephrotic syndrome (INS): steroid-sensitive (SSNS, n = 54), steroid-resistant (SRNS, n = 11), as well as in healthy controls (HC, n = 30). Group differences, clinical correlations and PD-1's predictive value for SRNS were analyzed. Circulating T subsets, including CD3⁺PD-1⁺ T cells, CD4⁺PD-1⁺T cells, and CD8⁺PD-1⁺T were detected with multiparameter flow cytometry. The percentage of CD4⁺PD-1⁺ T cells was significantly higher in SRNS (10.77 ± 4.62%) compared to both SSNS (5.14 ± 1.99%, P = 0.000) and HC (6.36 ± 2.02%, P = 0.028). CD3⁺PD-1⁺ T cells were also elevated in SRNS (8.13 ± 3.12%) versus SSNS (4.67 ± 1.82%, P = 0.001). No significant difference was found in CD8⁺PD-1⁺ T cells. Multivariate logistic regression identified an elevated percentage of CD4⁺PD-1⁺ T cells as an independent risk factor for SRNS (OR = 2.236, P = 0.002). Receiver operating characteristic (ROC) analysis showed that CD4⁺PD-1⁺ T cell cutoff > 7.385% predicted SRNS with an area under the curve (AUC) of 0.891, sensitivity of 81.8%, and specificity of 87.0%. Overexpression of PD-1, predominantly on CD4⁺ T cells, is associated with steroid resistance in pediatric INS. Elevated CD4⁺PD-1⁺ T cells may serve as a predictive biomarker for SRNS, offering a potential tool for early identification and a rationale for exploring PD-1 pathway modulation.
Open article ↗
