Rituximab in Glomerular Diseases- Evidence Based Approach

Authored by Sourabh Sharma, published on 2026-11-12 13:58:21.0

Confirm Diagnosis, Activity, Severity, Kidney Function, and Proteinuria
- Is Immunosuppressive Therapy Indicated?
  - Use Supportive Therapy and Disease-Specific Surveillance
  - Classify the Glomerular Disease
    - MN: Is Progression Risk Moderate, High, or Very High?
      - Use Supportive Therapy and Disease-Specific Surveillance
      - Proceed With Rituximab at the Evidence-Appropriate Role
        
        Screen HBV, HCV, HIV, TB Risk, CBC, IgG; Update Vaccines
        
        Uncontrolled Infection or Unmitigated Rituximab Risk?
        
        Correct Risks Before Rituximab or Choose an Alternative
        
        Select Induction, Retreatment, or AAV Maintenance Strategy
        
        Give 1 g IV Twice or 375 mg/m² Weekly ×4
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
        
        AAV Maintenance: Give 500 mg Twice, Then Every 6 Months
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
      - Use the Preferred Disease-Specific Non-Rituximab Pathway
    - GPA/MPA: Is Rituximab for Induction or Maintenance?
      - Proceed With Rituximab at the Evidence-Appropriate Role
        
        Screen HBV, HCV, HIV, TB Risk, CBC, IgG; Update Vaccines
        
        Uncontrolled Infection or Unmitigated Rituximab Risk?
        
        Correct Risks Before Rituximab or Choose an Alternative
        
        Select Induction, Retreatment, or AAV Maintenance Strategy
        
        Give 1 g IV Twice or 375 mg/m² Weekly ×4
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
        
        AAV Maintenance: Give 500 mg Twice, Then Every 6 Months
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
      - Use the Preferred Disease-Specific Non-Rituximab Pathway
    - MCD: Frequently Relapsing, Steroid-Dependent, or Treatment-Toxic?
      - Proceed With Rituximab at the Evidence-Appropriate Role
        
        Screen HBV, HCV, HIV, TB Risk, CBC, IgG; Update Vaccines
        
        Uncontrolled Infection or Unmitigated Rituximab Risk?
        
        Correct Risks Before Rituximab or Choose an Alternative
        
        Select Induction, Retreatment, or AAV Maintenance Strategy
        
        Give 1 g IV Twice or 375 mg/m² Weekly ×4
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
        
        AAV Maintenance: Give 500 mg Twice, Then Every 6 Months
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
      - Use the Preferred Disease-Specific Non-Rituximab Pathway
    - FSGS: Primary Steroid-Dependent or Refractory Selected Case?
      - Use Supportive Therapy and Disease-Specific Surveillance
      - Proceed With Rituximab at the Evidence-Appropriate Role
        
        Screen HBV, HCV, HIV, TB Risk, CBC, IgG; Update Vaccines
        
        Uncontrolled Infection or Unmitigated Rituximab Risk?
        
        Correct Risks Before Rituximab or Choose an Alternative
        
        Select Induction, Retreatment, or AAV Maintenance Strategy
        
        Give 1 g IV Twice or 375 mg/m² Weekly ×4
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
        
        AAV Maintenance: Give 500 mg Twice, Then Every 6 Months
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
      - Use the Preferred Disease-Specific Non-Rituximab Pathway
    - LN or Other Disease Refractory to Standard Therapy?
      - Proceed With Rituximab at the Evidence-Appropriate Role
        
        Screen HBV, HCV, HIV, TB Risk, CBC, IgG; Update Vaccines
        
        Uncontrolled Infection or Unmitigated Rituximab Risk?
        
        Correct Risks Before Rituximab or Choose an Alternative
        
        Select Induction, Retreatment, or AAV Maintenance Strategy
        
        Give 1 g IV Twice or 375 mg/m² Weekly ×4
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
        
        AAV Maintenance: Give 500 mg Twice, Then Every 6 Months
        
        Premedicate and Infuse With Reaction-Ready Monitoring
        
        Monitor Proteinuria, Kidney Function, Serology, CD19 B-Cell Counts, IgG, and CBC
        
        Serious Toxicity? If No, Assess Response or Relapse
        
        Sustain Remission and Continue Disease-Specific Follow-Up
        
        Continue Observation for Improving Partial or Delayed Response
        
        Verify Diagnosis and B-Cell Depletion; Switch Therapy
        
        Retreat Prior Responders or Start an Alternative
        
        Hold Rituximab and Treat Infection or Immune Toxicity
      - Use the Preferred Disease-Specific Non-Rituximab Pathway

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