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<p>Rituximab (RTX) is widely used as first-line therapy for PLA2R-associated membranous nephropathy (MN), but the optimal timing for assessing response and guiding retreatment remains uncertain, particularly in patients with slow clinical improvement. We report a 46-year-old man with PLA<sub>2</sub>R-associated MN who showed poor response to high-dose glucocorticoids and was subsequently treated with a low-dose, fractionated RTX regimen (total 3.6&#xa0;g over 14 months).Notably, a significant reduction in proteinuria was not observed until 19 months after treatment initiation, when partial remission (proteinuria &lt; 3.5&#xa0;g/day) was first achieved. During 44 months of follow-up, proteinuria continued to decline and remission was maintained, while anti-PLA<sub>2</sub>R antibodies remained negative despite gradual reconstitution of circulating CD19⁺ B cells, and no further immunosuppressive therapy was administered.This case demonstrates a markedly delayed but durable clinical response to rituximab and illustrates that B-cell repopulation does not necessarily indicate disease relapse when anti-PLA<sub>2</sub>R antibodies remain suppressed, supporting the value of antibody-guided rather than B-cell-guided monitoring in slow responders.</p>

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Delayed but durable remission to rituximab in PLA2R-associated membranous nephropathy despite B-cell reconstitution: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月13日

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  • Rushuang Yang,
  • Hongjie Zhu,
  • Ziyan Luo,
  • Tingting He,
  • Mei Jiang,
  • Yanling Zhang,
  • Ting Wang

摘要

Rituximab (RTX) is widely used as first-line therapy for PLA2R-associated membranous nephropathy (MN), but the optimal timing for assessing response and guiding retreatment remains uncertain, particularly in patients with slow clinical improvement. We report a 46-year-old man with PLA2R-associated MN who showed poor response to high-dose glucocorticoids and was subsequently treated with a low-dose, fractionated RTX regimen (total 3.6 g over 14 months).Notably, a significant reduction in proteinuria was not observed until 19 months after treatment initiation, when partial remission (proteinuria < 3.5 g/day) was first achieved. During 44 months of follow-up, proteinuria continued to decline and remission was maintained, while anti-PLA2R antibodies remained negative despite gradual reconstitution of circulating CD19⁺ B cells, and no further immunosuppressive therapy was administered.This case demonstrates a markedly delayed but durable clinical response to rituximab and illustrates that B-cell repopulation does not necessarily indicate disease relapse when anti-PLA2R antibodies remain suppressed, supporting the value of antibody-guided rather than B-cell-guided monitoring in slow responders.