case_images: PMC10853342_01
case_images: Clinical course, proteinuria, phospholipase A2 receptor antibody (PLA2R Ab), albumin and creatinine level in the case. (A): Historical view of immunosuppressive treatment with a detail on rituximab and obinutuzumab administrations. Pred, prednisone; CTX, cyclophosphamide; Fk-506, tacrolimus; MMF, mycophenolate mofetil; RTX, rituximab; OB, obinutuzumab. (B): Proteinuria and PLA2R Ab trends in relation to the treatments. (C): creatinine (Scr) and albumin (Alb) trends in relation to the treatments.
case_images: fphar-15-1347880-g001.jpg
case_images: PMC10853342_01_fphar-15-1347880-g001.jpg
case_images: F1
case_images: Despite 4 months of subsequent MMF therapy, the patient did not respond and was given two intravenous doses of RTX (1 g x 2), 2 weeks apart (Figure 1A). Seven months later, the patient's Scr level was recorded at 160umol/L, serum albumin at 20.6 g/L, and UP at 19 g/d, with a PLA2R antibody titer of 396 RU/mL (Figures 1B, C).
case_images: Electrocardiograms (ECG) before (A) and after rituximab administration when hypokalemia occurred (B).
case_images: fphar-15-1347880-g002.jpg
case_images: PMC10853342_01_fphar-15-1347880-g002.jpg
case_images: F2
case_images: T waves, and chest leads indicating U waves and T-U fusion waves (Figure 2). The patient's blood glucose level was measured and found to be 9.2 mmol/L.
case_images: Potassium levels (mmol/L) over time and potassium central laboratory normal value (3.5 mmol/L, dotted line). RTX, rituximab; OB, obinutuzumab.
case_images: fphar-15-1347880-g003.jpg
case_images: PMC10853342_01_fphar-15-1347880-g003.jpg
case_images: F3
case_images: In May 2023 (Figure 3), the patient's proteinuria decreased by 50%, with a quantitative 24-h urine protein level of 11 g and a blood albumin level of 32.5 g/L (the highest recorded since treatment).