Primary forms of minimal change disease and focal segmental glomerulosclerosis are rare podocytopathies and clinically characterized by nephrotic syndrome. Glucocorticoids are the cornerstone of the initial immunosuppressive treatment in these two entities. Especially among adults with minimal change disease or focal segmental glomerulosclerosis, relapses, steroid dependence or resistance are common and necessitate re-initiation of steroids and other immunosuppressants. Effective steroid-sparing therapies and introduction of less toxic immunosuppressive agents are urgently needed to reduce undesirable side effects, in particular for patients whose disease course is complex. Rituximab, a B cell depleting monoclonal antibody, is increasingly used off-label in these circumstances, despite a low level of evidence for adult patients. Hence, critical questions concerning drug-safety, long-term efficacy and the optimal regimen for rituximab-treatment remain unanswered. Evidence in the form of large, multicenter studies and randomized controlled trials are urgently needed to overcome these limitations.

Centre for Translational Inflammation Research University of Birmingham Research Laboratories Queen Elizabeth Hospital Mindelsohn Way Edgbaston Birmingham B15 2WB UK

Clinical Division of Nephrology Department of Internal Medicine Medical University of Graz Graz Austria

Département de Néphrologie et Transplantation d'Organes Centre de Référence des Maladies Rénales Rares Centre Hospitalier Universitaire de Toulouse 31000 Toulouse France; Institut National de la Santé et de la Recherche Médicale U1048 31000 Toulouse France

Department of Cardiovascular Sciences University of Leicester Leicester United Kingdom; John Walls Renal Unit University Hospitals of Leicester NHS Trust Leicester United Kingdom

Department of Clinical Sciences Lund University Skane University Hospital Nephrology Lund Lund Sweden

Department of Internal Medicine 3 University Hospital Jena Friedrich Schiller University Jena Germany

Department of Internal Medicine 4 Medical University Innsbruck Anichstrasse 35 6020 Innsbruck Austria

Department of Internal Medicine 4 Section of Nephrology Klinikum Wels Grieskirchen Wels Austria; Medical Faculty Johannes Kepler University Linz Altenberger Strasse 69 4040 Linz Austria

Department of Nephrology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Nephrology and Dialysis Dubrava University Hospital Avenija Gojka Suska 6 10 000 Zagreb Croatia

Department of Nephrology and Renal Transplantation Hospital Clínic Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud Department of Medicine University of Barcelona IDIBAPS Barcelona Spain

Department of Nephrology and Transplantation Rare French Disease Centre Idiopathic Nephrotic syndrome Henri Mondor Albert Chenevier Hospital Assistance Publique Hôpitaux de Paris Inserm U955 Team 21 Paris East University 94000 Créteil France

Department of Nephrology and Transplantation University Hospital of Wales Cardiff UK

Department of Nephrology Juntendo University Faculty of Medicine Tokyo Japan

Department of Nephrology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen Netherlands

Department of Nephrology University of Brescia Hospital of Montichiari Brescia Italy

Department of Pediatrics Yonsei University College of Medicine Seoul 03722 Republic of Korea; Division of Pediatric Nephrology Severance Children's Hospital Seoul 03722 Republic of Korea; Institute of Kidney Disease Research Yonsei University College of Medicine Seoul 03722 Republic of Korea

Department of Renal Medicine CLINTEC Karolinska Institutet at Karolinska University Hospital Stockholm Sweden; Department of Health Medicine and Caring Sciences Linköping University Linköping Sweden

Department of Renal Medicine Vasculitis and Lupus Clinic Addenbrooke's Hospital Cambridge University Hospitals Cambridge UK

Division of Nephrology and Hypertension Mayo Clinic Rochester MN USA

Division of Nephrology Columbia University Medical Center NY New York USA

Division of Nephrology Vasculitis and Glomerulonephritis Center Massachusetts General Hospital 101 Merrimac Street Boston MA 02114 USA

Nephrology Post Graduate Institute of Medical Education and Research Chandigarh India

Nephrology Unit ASST Spedali Civili di Brescia Brescia Italy; Department of Medical and Surgical Specialities Radiological Sciences and Public Health University of Brescia Brescia Italy

Service de Néphrologie Hôpital Européen Georges Pompidou Assistance Publique des Hôpitaux de Paris 75015 Paris France

Tareev Clinic of Internal Diseases Sechenov 1st Moscow State Medical University Moscow Russia

University College London Department of Renal Medicine Royal Free Hospital London UK

References provided by Crossref.org

Implications of rituximab pharmacokinetic and pharmacodynamic alterations in various immune-mediated glomerulopathies and potential anti-CD20 therapy alternatives