The boy has received treatment with steroids, cyclophosphamide and cyclosporine A, without a good response.
Is in your country rituximab registered for this age and this indication. I have seen amazing responses in steroid resistant 16 year old, but can not speak for children this age.
Do not believe in plasma pheresis for this indication.
Plasma pheresis would not be our choice. Rituximab has probably the best effects, depending on the degree of glomerulosclerosis. We use rituximab even in children at very young ages (e.g. Kawasaki Disease in infants) with excellent results.
Best Chris
I would reconsider diagnosis of minimal change with repeat biopsy and electron microscopy. FSGS with sampling error and C1q nephropathy are other possibilities and would lead to poor response with above drugs.
You could try tacrolimus 0.06mg/kg/day with T0 monitoring, as some times patients with poor response to CyA, responds to Tac.
I don't see how plamapheresis is going to improve outcome given lack of circulating, filterable immune complexes in MCD.
Thank you for your answers. In my department there was controversy about the management of this case. I agree with you that plasmapheresis is not indicated, but I wanted to know the opinion of some experts in this field.
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