Il rituximab nella terapia delle glomerulonefriti primitive e secondarie [Use of rituximab in primary and secondary glomerulonephritis]

Primary and secondary glomerulonephritis are a heterogeneous group of disorders characterized by "glomerular inflammation" with an immune-mediated pathogenesis. Considering the severe side effects of the immunosuppressive drugs, the therapeutic approach remains a challenge for the nephrologists. Corticosteroids, cytotoxic agents such as cyclophosphamide, or calcineurin inhibitors such as cyclosporine and tacrolimus, azathioprine and mycophenolate mofetil can all be used for the treatment of glomerulonephritis. Several studies has been published to better understand the pathogenesis of these diseases and to identify the drugs with lower toxicity. Different mechanisms involve, directly or indirectly, the B cells in the pathogenesis of glomerulonephritis. For this reason, the attention of the nephrologists has been focused on the identification of drugs that act at this level, such as chimeric monoclonal antibodies. Rituximab, binding to the CD20 receptor expressed on the surface of B cells, induces their apoptosis and persistent depletion for 6-9 months. B cells contribute to the immune response by the maturation into plasma cells with consequent antibody production, the processing and presentation of the antigen to T cells and the production of various cytokines. For these reasons, the potential role of these drugs in the treatment of primitives and secondary glomerulonephritis is clear. In this review, we aimed to evaluate the use of rituximab in the treatment of these diseases, by focusing on the results of the most recent clinical trials.