{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:45:20Z","timestamp":1792107920454,"version":"4.4.0"},"reference-count":63,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["NRRP M6C2"],"award-info":[{"award-number":["NRRP M6C2"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Podocytopathies, including minimal change disease and focal segmental glomerulosclerosis, represent the leading causes of nephrotic syndrome in children and adolescents. Although traditionally considered T-cell\u2013mediated disorders, growing evidence over the last decade has reshaped this paradigm, highlighting a central role for B-cells, plasma cells, and humoral immune mechanisms in podocyte injury. The identification of pathogenic autoantibodies, particularly anti-nephrin IgG, and the involvement of complement activation have provided a strong mechanistic rationale for B-cell\u2013targeted therapies. Rituximab, an anti-CD20 monoclonal antibody, has become an established steroid-sparing agent in steroid-dependent and frequently relapsing nephrotic syndrome, significantly reducing relapse rates and cumulative steroid exposure in pediatric patients. However, its efficacy is limited in steroid-resistant disease and in settings characterized by persistent autoantibody production or post-transplant recurrence. These limitations have prompted the exploration of next-generation anti-CD20 agents, such as obinutuzumab, which achieve deeper and more sustained B-cell depletion, as well as therapies targeting long-lived plasma cells, including anti-CD38 monoclonal antibodies. Emerging clinical data suggest that combined B-cell and plasma cell targeting may induce durable remission in refractory podocytopathies and recurrent post-transplant focal segmental glomerulosclerosis, while maintaining an acceptable safety profile. In parallel, novel strategies targeting the BAFF\/APRIL axis and cellular therapies such as CAR-T cells are under investigation. This review summarizes current evidence on B-cell\u2013directed therapies in podocytopathies, mostly in pediatrics, discusses unmet clinical needs, and outlines future perspectives toward precision, mechanism-based immunotherapy.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>A higher resolution version of the  Graphical abstract is available as Supplementary information<\/jats:p>","DOI":"10.1007\/s00467-026-07297-4","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T19:34:09Z","timestamp":1776540849000},"page":"4259-4269","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["B-cell-targeting therapies in podocytopathies"],"prefix":"10.1007","volume":"41","author":[{"given":"Carolina","family":"Bigatti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cravedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6121-5326","authenticated-orcid":false,"given":"Andrea","family":"Angeletti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"key":"7297_CR1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1053\/j.akdh.2024.10.004","volume":"32","author":"M Navarro-Torres","year":"2025","unstructured":"Navarro-Torres M, Wooden B, Santoriello D, Radhakrishnan J, Bomback AS (2025) Podocytopathies. Adv Kidney Dis Health 32:2\u201311","journal-title":"Adv Kidney Dis Health"},{"key":"7297_CR2","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/S0140-6736(23)01051-6","volume":"402","author":"M Vivarelli","year":"2023","unstructured":"Vivarelli M, Gibson K, Sinha A, Boyer O (2023) Childhood nephrotic syndrome. Lancet 402:809\u2013824","journal-title":"Lancet"},{"key":"7297_CR3","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/S0140-6736(74)91880-7","volume":"2","author":"RJ Shalhoub","year":"1974","unstructured":"Shalhoub RJ (1974) Pathogenesis of lipoid nephrosis: a disorder of T-cell function. Lancet 2:556\u2013560","journal-title":"Lancet"},{"key":"7297_CR4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2025.09.021","author":"M Laslandes","year":"2025","unstructured":"Laslandes M, Lorent M, Brilland B, Boulay H, Golbin L, Barbet C, Grellier J, Dujardin A, Larmet D, Testa A, Pfirmann P, Thierry A, Ville S, Dantal J, Masset C (2025) Response to rituximab as a maintenance therapy in adult idiopathic nephrotic syndrome: a French multicenter cohort study. Am J Kidney Dis. https:\/\/doi.org\/10.1053\/j.ajkd.2025.09.021","journal-title":"Am J Kidney Dis"},{"key":"7297_CR5","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1681\/ASN.2015050523","volume":"27","author":"M Colucci","year":"2016","unstructured":"Colucci M, Carsetti R, Cascioli S, Casiraghi F, Perna A, Rava L, Ruggiero B, Emma F, Vivarelli M (2016) B cell reconstitution after rituximab treatment in idiopathic nephrotic syndrome. J Am Soc Nephrol 27:1811\u20131822","journal-title":"J Am Soc Nephrol"},{"key":"7297_CR6","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.726428","volume":"12","author":"M Fribourg","year":"2021","unstructured":"Fribourg M, Cioni M, Ghiggeri G, Cantarelli C, Leventhal JS, Budge K, Bin S, Riella LV, Colucci M, Vivarelli M, Angeletti A, Perin L, Cravedi P (2021) CyTOF-enabled analysis identifies class-switched B cells as the main lymphocyte subset associated with disease relapse in children with idiopathic nephrotic syndrome. Front Immunol 12:726428","journal-title":"Front Immunol"},{"key":"7297_CR7","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1056\/NEJMoa2314471","volume":"391","author":"FE Hengel","year":"2024","unstructured":"Hengel FE, Dehde S, Lasse M, Zahner G, Seifert L, Schnarre A, Kretz O, Demir F, Pinnschmidt HO, Grahammer F, Lucas R, Mehner LM, Zimmermann T, Billing AM, Oh J, Mitrotti A, Pontrelli P, Debiec H, Dossier C, Colucci M, Emma F, Smoyer WE, Weins A, Schaefer F, Alachkar N, Diemert A, Hogan J, Hoxha E, Wiech T, Rinschen MM, Ronco P, Vivarelli M, Gesualdo L, Tomas NM, Huber TB, International Society of Glomerular Disease (2024) Autoantibodies targeting nephrin in podocytopathies. N Engl J Med 391:422\u2013433","journal-title":"N Engl J Med"},{"key":"7297_CR8","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1042\/BCJ20230234","volume":"482","author":"CR Williamson","year":"2025","unstructured":"Williamson CR, Pantic UV, Wang AY, Jones N (2025) Revisiting nephrin signaling and its specialized effects on the uniquely adaptable podocyte. Biochem J 482:763\u2013788","journal-title":"Biochem J"},{"key":"7297_CR9","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1093\/ndt\/gfaf156","volume":"41","author":"V Raglianti","year":"2025","unstructured":"Raglianti V, Angelotti ML, De Chiara L, Romagnani P (2025) Anti-nephrin, anti-podocin and anti-Kirrel1 antibodies: biological challenges and clinical implications. Nephrol Dial Transplant 41:428\u2013436","journal-title":"Nephrol Dial Transplant"},{"key":"7297_CR10","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-43504-8","volume":"14","author":"TA Al-Aubodah","year":"2023","unstructured":"Al-Aubodah TA, Aoudjit L, Pascale G, Perinpanayagam MA, Langlais D, Bitzan M, Samuel SM, Piccirillo CA, Takano T (2023) The extrafollicular B cell response is a hallmark of childhood idiopathic nephrotic syndrome. Nat Commun 14:7682","journal-title":"Nat Commun"},{"key":"7297_CR11","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1038\/ki.2015.120","volume":"88","author":"SE Panzer","year":"2015","unstructured":"Panzer SE, Laskowski J, Renner B, Kulik L, Ljubanovic D, Huber KM, Zhong W, Pickering MC, Holers VM, Thurman JM (2015) IgM exacerbates glomerular disease progression in complement-induced glomerulopathy. Kidney Int 88:528\u2013537","journal-title":"Kidney Int"},{"key":"7297_CR12","doi-asserted-by":"crossref","first-page":"F505","DOI":"10.1152\/ajprenal.00041.2021","volume":"321","author":"H Trachtman","year":"2021","unstructured":"Trachtman H, Laskowski J, Lee C, Renner B, Feemster A, Parikh S, Panzer SE, Zhong W, Cravedi P, Cantarelli C, Kulik L, You Z, Satchell S, Rovin B, Liu F, Kalled SL, Holers VM, Jalal D, Thurman JM (2021) Natural antibody and complement activation characterize patients with idiopathic nephrotic syndrome. Am J Physiol Renal Physiol 321:F505\u2013F516","journal-title":"Am J Physiol Renal Physiol"},{"key":"7297_CR13","volume":"15","author":"J Huang","year":"2020","unstructured":"Huang J, Cui Z, Gu QH, Zhang YM, Qu Z, Wang X, Wang F, Cheng XY, Meng LQ, Liu G, Zhao MH (2020) Complement activation profile of patients with primary focal segmental glomerulosclerosis. PLoS One 15:e0234934","journal-title":"PLoS One"},{"key":"7297_CR14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0136558","volume":"10","author":"JM Thurman","year":"2015","unstructured":"Thurman JM, Wong M, Renner B, Frazer-Abel A, Giclas PC, Joy MS, Jalal D, Radeva MK, Gassman J, Gipson DS, Kaskel F, Friedman A, Trachtman H (2015) Complement activation in patients with focal segmental glomerulosclerosis. PLoS One 10:e0136558","journal-title":"PLoS One"},{"key":"7297_CR15","doi-asserted-by":"crossref","unstructured":"(1978) Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Int 13:159\u2013165","DOI":"10.1038\/ki.1978.23"},{"key":"7297_CR16","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-025-00671-w","volume":"11","author":"P Romagnani","year":"2025","unstructured":"Romagnani P, Tang SCW, Weins A, Huber TB, Osafo C, Anders HJ (2025) Podocytopathies. Nat Rev Dis Primers 11:87","journal-title":"Nat Rev Dis Primers"},{"key":"7297_CR17","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1007\/s00467-004-1434-z","volume":"19","author":"K Benz","year":"2004","unstructured":"Benz K, Dotsch J, Rascher W, Stachel D (2004) Change of the course of steroid-dependent nephrotic syndrome after rituximab therapy. Pediatr Nephrol 19:794\u2013797","journal-title":"Pediatr Nephrol"},{"key":"7297_CR18","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1007\/s00467-005-2013-7","volume":"20","author":"K Nozu","year":"2005","unstructured":"Nozu K, Iijima K, Fujisawa M, Nakagawa A, Yoshikawa N, Matsuo M (2005) Rituximab treatment for posttransplant lymphoproliferative disorder (PTLD) induces complete remission of recurrent nephrotic syndrome. Pediatr Nephrol 20:1660\u20131663","journal-title":"Pediatr Nephrol"},{"key":"7297_CR19","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/S0140-6736(14)60541-9","volume":"384","author":"K Iijima","year":"2014","unstructured":"Iijima K, Sako M, Nozu K, Mori R, Tuchida N, Kamei K, Miura K, Aya K, Nakanishi K, Ohtomo Y, Takahashi S, Tanaka R, Kaito H, Nakamura H, Ishikura K, Ito S, Ohashi Y, Rituximab for Childhood-onset Refractory Nephrotic Syndrome Study Group (2014) Rituximab for childhood-onset, complicated, frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet 384:1273\u20131281","journal-title":"Lancet"},{"key":"7297_CR20","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1681\/ASN.2013030251","volume":"25","author":"P Ruggenenti","year":"2014","unstructured":"Ruggenenti P, Ruggiero B, Cravedi P, Vivarelli M, Massella L, Marasa M, Chianca A, Rubis N, Ene-Iordache B, Rudnicki M, Pollastro RM, Capasso G, Pisani A, Pennesi M, Emma F, Remuzzi G, Rituximab in Nephrotic Syndrome of Steroid-Dependent or Frequently Relapsing Minimal Change Disease Or Focal Segmental Glomerulosclerosis (NEMO) Study Group (2014) Rituximab in steroid-dependent or frequently relapsing idiopathic nephrotic syndrome. J Am Soc Nephrol 25:850\u2013863","journal-title":"J Am Soc Nephrol"},{"key":"7297_CR21","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1681\/ASN.2021111472","volume":"33","author":"EY Chan","year":"2022","unstructured":"Chan EY, Yu ELM, Angeletti A, Arslan Z, Basu B, Boyer O, Chan CY, Colucci M, Dorval G, Dossier C, Drovandi S, Ghiggeri GM, Gipson DS, Hamada R, Hogan J, Ishikura K, Kamei K, Kemper MJ, Ma AL, Parekh RS, Radhakrishnan S, Saini P, Shen Q, Sinha R, Subun C, Teo S, Vivarelli M, Webb H, Xu H, Yap HK, Tullus K (2022) Long-term efficacy and safety of repeated rituximab to maintain remission in idiopathic childhood nephrotic syndrome: an international study. J Am Soc Nephrol 33:1193\u20131207","journal-title":"J Am Soc Nephrol"},{"key":"7297_CR22","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1681\/ASN.0000000520","volume":"36","author":"P Gauckler","year":"2025","unstructured":"Gauckler P, Matyjek A, Kapsia S, Marinaki S, Quintana LF, Diaz MM, King C, Griffin S, Ramachandran R, Odler B, Eller K, Artan AS, Mirioglu S, Busch M, Schaepe M, Turkmen K, Cheung CK, Pepper RJ, Juarez GF, Pascual J, Au\u00f1\u00f3n P, Garc\u00eda-Carro C, Rodriguez A, Alberici F, Luzardo L, Chebotareva N, Sch\u00f6nermarck U, Fern\u00e1ndez L, Radhakrishnan J, Guaman K, Peleg Y, Hoisnard L, Audard V, Papasotiriou M, Krnanska N, Tesar V, Hruskova Z, Bruchfeld A, Stangou M, Lioulios G, Faguer S, Ribes D, Salhi S, Windpessl M, Gale\u0161i\u0107 K, Crnogorac M, Zagorec N, Mayer G, Kronbichler A, RITERM Study Team (2025) Long-term outcomes of rituximab-treated adult patients with podocytopathies. J Am Soc Nephrol 36:668\u2013678","journal-title":"J Am Soc Nephrol"},{"key":"7297_CR23","doi-asserted-by":"crossref","first-page":"2751","DOI":"10.1056\/NEJMc063706","volume":"356","author":"A Bagga","year":"2007","unstructured":"Bagga A, Sinha A, Moudgil A (2007) Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med 356:2751\u20132752","journal-title":"N Engl J Med"},{"key":"7297_CR24","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.2215\/CJN.03470410","volume":"5","author":"A Gulati","year":"2010","unstructured":"Gulati A, Sinha A, Jordan SC, Hari P, Dinda AK, Sharma S, Srivastava RN, Moudgil A, Bagga A (2010) Efficacy and safety of treatment with rituximab for difficult steroid-resistant and -dependent nephrotic syndrome: multicentric report. Clin J Am Soc Nephrol 5:2207\u20132212","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"7297_CR25","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1681\/ASN.2011080775","volume":"23","author":"A Magnasco","year":"2012","unstructured":"Magnasco A, Ravani P, Edefonti A, Murer L, Ghio L, Belingheri M, Benetti E, Murtas C, Messina G, Massella L, Porcellini MG, Montagna M, Regazzi M, Scolari F, Ghiggeri GM (2012) Rituximab in children with resistant idiopathic nephrotic syndrome. J Am Soc Nephrol 23:1117\u20131124","journal-title":"J Am Soc Nephrol"},{"key":"7297_CR26","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.kint.2024.09.011","volume":"106","author":"EY Chan","year":"2024","unstructured":"Chan EY, Sinha A, Yu ELM, Akhtar N, Angeletti A, Bagga A, Banerjee S, Boyer O, Chan CY, Francis A, Ghiggeri GM, Hamada R, Hari P, Hooman N, Hopf LS, I MI, Ijaz I, Ivanov DD, Kalra S, Kang HG, Lucchetti L, Lugani F, Ma AL, Morello W, Camargo Mu\u00f1iz MD, Pradhan SK, Prikhodina L, Raafat RH, Sinha R, Teo S, Tomari K, Vivarelli M, Webb H, Yap HK, Yap DY, Tullus K (2024) An international, multi-center study evaluated rituximab therapy in childhood steroid-resistant nephrotic syndrome. Kidney Int 106:1146\u20131157","journal-title":"Kidney Int"},{"key":"7297_CR27","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.36321","volume":"4","author":"CL McAtee","year":"2021","unstructured":"McAtee CL, Lubega J, Underbrink K, Curry K, Msaouel P, Barrow M, Muscal E, Lotze T, Srivaths P, Forbes LR, Allen C, Bernhardt MB (2021) Association of rituximab use with adverse events in children, adolescents, and young adults. JAMA Netw Open 4:e2036321","journal-title":"JAMA Netw Open"},{"key":"7297_CR28","doi-asserted-by":"publisher","first-page":"2003","DOI":"10.1007\/s00467-020-04629-w","volume":"35","author":"S Fujinaga","year":"2020","unstructured":"Fujinaga S, Nishino T, Endo S, Umeda C, Watanabe Y, Nakagawa M (2020) Unfavorable impact of anti-rituximab antibodies on clinical outcomes in children with complicated steroid-dependent nephrotic syndrome. Pediatr Nephrol 35:2003\u20132008","journal-title":"Pediatr Nephrol"},{"key":"7297_CR29","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1016\/j.ekir.2022.08.006","volume":"7","author":"A Angeletti","year":"2022","unstructured":"Angeletti A, Bruschi M, Colucci M, Kajana X, La Porta E, Caridi G, Lugani F, Ravani P, Vivarelli M, Cravedi P, Ghiggeri GM (2022) Circulating anti-rituximab antibodies do not affect response to rituximab in steroid-dependent nephrotic syndrome. Kidney Int Rep 7:2509\u20132512","journal-title":"Kidney Int Rep"},{"key":"7297_CR30","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1093\/ndt\/gfac228","volume":"38","author":"A Sinha","year":"2023","unstructured":"Sinha A, Mathew G, Arushi A, Govindarajan S, Ghanapriya K, Grewal N, Rai K, Brijwal M, Kalluru SL, Tewari P, Misra A, Khandelwal P, Hari P, Bagga A (2023) Sequential rituximab therapy sustains remission of nephrotic syndrome but carries high risk of adverse effects. Nephrol Dial Transplant 38:939\u2013949","journal-title":"Nephrol Dial Transplant"},{"key":"7297_CR31","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/MOP.0000000000001396","volume":"36","author":"D DiGiacomo","year":"2024","unstructured":"DiGiacomo D, Barmettler S (2024) Secondary hypogammaglobulinemia: diagnosis and management of a pediatric condition of clinical importance. Curr Opin Pediatr 36:659\u2013667","journal-title":"Curr Opin Pediatr"},{"key":"7297_CR32","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1007\/s00467-022-05652-9","volume":"38","author":"Y Inoki","year":"2023","unstructured":"Inoki Y, Nishi K, Sato M, Ogura M, Kamei K (2023) The association between hypogammaglobulinemia severity and infection risk in rituximab-treated patients with childhood-onset idiopathic nephrotic syndrome. Pediatr Nephrol 38:451\u2013460","journal-title":"Pediatr Nephrol"},{"key":"7297_CR33","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1007\/s00467-021-05304-4","volume":"37","author":"Y Inoki","year":"2022","unstructured":"Inoki Y, Kamei K, Nishi K, Sato M, Ogura M, Ishiguro A (2022) Incidence and risk factors of rituximab-associated hypogammaglobulinemia in patients with complicated nephrotic syndrome. Pediatr Nephrol 37:1057\u20131066","journal-title":"Pediatr Nephrol"},{"key":"7297_CR34","doi-asserted-by":"crossref","DOI":"10.1016\/j.ebiom.2023.104712","volume":"94","author":"P Holma","year":"2023","unstructured":"Holma P, Pesonen P, Karjalainen MK, Jarvelin MR, Vayrynen S, Sliz E, Heikkila A, Seppanen MRJ, Kettunen J, Auvinen J, Hautala T (2023) Low and high serum IgG associates with respiratory infections in a young and working age population. EBioMedicine 94:104712","journal-title":"EBioMedicine"},{"key":"7297_CR35","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1097\/MD.0b013e3181f2caef","volume":"89","author":"O Wolach","year":"2010","unstructured":"Wolach O, Bairey O, Lahav M (2010) Late-onset neutropenia after rituximab treatment: case series and comprehensive review of the literature. Medicine (Baltimore) 89:308\u2013318","journal-title":"Medicine (Baltimore)"},{"key":"7297_CR36","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1046\/j.1365-2141.2003.04385.x","volume":"121","author":"K Chaiwatanatorn","year":"2003","unstructured":"Chaiwatanatorn K, Lee N, Grigg A, Filshie R, Firkin F (2003) Delayed-onset neutropenia associated with rituximab therapy. Br J Haematol 121:913\u2013918","journal-title":"Br J Haematol"},{"key":"7297_CR37","doi-asserted-by":"crossref","first-page":"S241","DOI":"10.1016\/j.kint.2024.11.007","volume":"107","author":"J Floege","year":"2025","unstructured":"Kidney Disease: Improving Global Outcomes Nephrotic Syndrome In Children Work Group, Floege J, Gibson KL, Vivarelli M, Liew A, Radhakrishnan J, Rovin BH (2025) KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. Kidney Int 107:S241\u2013S289","journal-title":"Kidney Int"},{"key":"7297_CR38","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s00467-018-4052-x","volume":"34","author":"J Hogan","year":"2019","unstructured":"Hogan J, Dossier C, Kwon T, Macher MA, Maisin A, Couderc A, Niel O, Baudouin V, Deschenes G (2019) Effect of different rituximab regimens on B cell depletion and time to relapse in children with steroid-dependent nephrotic syndrome. Pediatr Nephrol 34:253\u2013259","journal-title":"Pediatr Nephrol"},{"key":"7297_CR39","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1007\/s00467-018-4172-3","volume":"34","author":"AP Maxted","year":"2019","unstructured":"Maxted AP, Dalrymple RA, Chisholm D, McColl J, Tse Y, Christian MT, Reynolds BC (2019) Low-dose rituximab is no less effective for nephrotic syndrome measured by 12-month outcome. Pediatr Nephrol 34:855\u2013863","journal-title":"Pediatr Nephrol"},{"key":"7297_CR40","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.kint.2019.09.033","volume":"97","author":"EY Chan","year":"2020","unstructured":"Chan EY, Webb H, Yu E, Ghiggeri GM, Kemper MJ, Ma AL, Yamamura T, Sinha A, Bagga A, Hogan J, Dossier C, Vivarelli M, Liu ID, Kamei K, Ishikura K, Saini P, Tullus K (2020) Both the rituximab dose and maintenance immunosuppression in steroid-dependent\/frequently-relapsing nephrotic syndrome have important effects on outcomes. Kidney Int 97:393\u2013401","journal-title":"Kidney Int"},{"key":"7297_CR41","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1056\/NEJMc1308488","volume":"370","author":"B Basu","year":"2014","unstructured":"Basu B (2014) Ofatumumab for rituximab-resistant nephrotic syndrome. N Engl J Med 370:1268\u20131270","journal-title":"N Engl J Med"},{"key":"7297_CR42","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1007\/s00467-017-3621-8","volume":"32","author":"CS Wang","year":"2017","unstructured":"Wang CS, Liverman RS, Garro R, George RP, Glumova A, Karp A, Jernigan S, Warshaw B (2017) Ofatumumab for the treatment of childhood nephrotic syndrome. Pediatr Nephrol 32:835\u2013841","journal-title":"Pediatr Nephrol"},{"key":"7297_CR43","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1007\/s00467-020-04481-y","volume":"35","author":"P Ravani","year":"2020","unstructured":"Ravani P, Pisani I, Bodria M, Caridi G, Degl\u2019Innocenti ML, Ghiggeri GM (2020) Low-dose ofatumumab for multidrug-resistant nephrotic syndrome in children: a randomized placebo-controlled trial. Pediatr Nephrol 35:997\u20131003","journal-title":"Pediatr Nephrol"},{"key":"7297_CR44","doi-asserted-by":"crossref","DOI":"10.1111\/petr.13175","volume":"22","author":"J Bernard","year":"2018","unstructured":"Bernard J, Bruel A, Allain-Launay E, Dantal J, Roussey G (2018) Ofatumumab in post-transplantation recurrence of a pediatric steroid-resistant idiopathic nephrotic syndrome. Pediatr Transplant 22:e13175","journal-title":"Pediatr Transplant"},{"key":"7297_CR45","doi-asserted-by":"crossref","first-page":"2652","DOI":"10.1681\/ASN.2021040561","volume":"32","author":"P Ravani","year":"2021","unstructured":"Ravani P, Colucci M, Bruschi M, Vivarelli M, Cioni M, DiDonato A, Cravedi P, Lugani F, Antonini F, Prunotto M, Emma F, Angeletti A, Ghiggeri GM (2021) Human or chimeric monoclonal anti-cd20 antibodies for children with nephrotic syndrome: a superiority randomized trial. J Am Soc Nephrol 32:2652\u20132663","journal-title":"J Am Soc Nephrol"},{"key":"7297_CR46","doi-asserted-by":"crossref","first-page":"2894","DOI":"10.1093\/rheumatology\/keab827","volume":"61","author":"VR Reddy","year":"2022","unstructured":"Reddy VR, Pepper RJ, Shah K, Cambridge G, Henderson SR, Klein C, Kell L, Taylor SJ, Isenberg DA, Cragg MS, Leandro MJ (2022) Disparity in peripheral and renal B-cell depletion with rituximab in systemic lupus erythematosus: an opportunity for obinutuzumab? Rheumatology (Oxford) 61:2894\u20132904","journal-title":"Rheumatology (Oxford)"},{"key":"7297_CR47","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1016\/j.ekir.2025.06.019","volume":"10","author":"A Angeletti","year":"2025","unstructured":"Angeletti A, Caridi G, Kajana X, Bigatti C, Spennacchio A, Chiarenza DS, Mortari G, Cravedi P, Verrina EE (2025) Obinutuzumab in rituximab-resistant podocytopathies: a single-center experience. Kidney Int Rep 10:2873\u20132874","journal-title":"Kidney Int Rep"},{"key":"7297_CR48","doi-asserted-by":"crossref","DOI":"10.1016\/j.xkme.2025.101057","volume":"7","author":"T Loeffler","year":"2025","unstructured":"Loeffler T, Flahault A, Alla A, Frimat L, Kormann R (2025) Obinutuzumab, an anti-CD20, in refractory adult autoimmune podocytopathies: report of 2 cases. Kidney Med 7:101057","journal-title":"Kidney Med"},{"key":"7297_CR49","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.2215\/CJN.0000000000000288","volume":"18","author":"C Dossier","year":"2023","unstructured":"Dossier C, Bonneric S, Baudouin V, Kwon T, Prim B, Cambier A, Couderc A, Moreau C, Deschenes G, Hogan J (2023) Obinutuzumab in frequently relapsing and steroid-dependent nephrotic syndrome in children. Clin J Am Soc Nephrol 18:1555\u20131562","journal-title":"Clin J Am Soc Nephrol"},{"key":"7297_CR50","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1056\/NEJMoa2410965","volume":"392","author":"RA Furie","year":"2025","unstructured":"Furie RA, Rovin BH, Garg JP, Santiago MB, Aroca-Mart\u00ednez G, Zuta Santill\u00e1n AE, Alvarez D, Navarro Sandoval C, Lila AM, Tumlin JA, Saxena A, Irazoque Palazuelos F, Raghu H, Yoo B, Hassan I, Martins E, Sehgal H, Kirchner P, Ross Terres J, Omachi TA, Schindler T, Pendergraft WF 3rd, Malvar A, REGENCY Trial Investigators (2025) Efficacy and safety of obinutuzumab in active lupus nephritis. N Engl J Med 392:1471\u20131483","journal-title":"N Engl J Med"},{"key":"7297_CR51","doi-asserted-by":"crossref","DOI":"10.1016\/j.xkme.2026.101268","volume":"8","author":"DS Chiarenza","year":"2026","unstructured":"Chiarenza DS, Verrina EE, Bigatti C, Caridi G, Spennacchio A, Kajana X, De Bortoli M, Cravedi P, Angeletti A (2026) B-cell depletion in glomerular diseases: not always as safe as we may think. Kidney Med 8:101268","journal-title":"Kidney Med"},{"key":"7297_CR52","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1007\/s00467-020-04811-0","volume":"36","author":"C Dossier","year":"2021","unstructured":"Dossier C, Prim B, Moreau C, Kwon T, Maisin A, Nathanson S, De Gennes C, Barsotti K, Bourrassi A, Hogan J, Desch\u00eanes G (2021) A global antiB cell strategy combining obinutuzumab and daratumumab in severe pediatric nephrotic syndrome. Pediatr Nephrol 36:1175\u20131182","journal-title":"Pediatr Nephrol"},{"key":"7297_CR53","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1016\/j.ekir.2024.04.006","volume":"9","author":"A Angeletti","year":"2024","unstructured":"Angeletti A, Bin S, Kajana X, Spinelli S, Bigatti C, Caridi G, Candiano G, Lugani F, Verrina EE, La Porta E, Magnasco A, Bruschi M, Cravedi P, Ghiggeri GM (2024) Combined rituximab and daratumumab treatment in difficult-to-treat nephrotic syndrome cases. Kidney Int Rep 9:1892\u20131896","journal-title":"Kidney Int Rep"},{"key":"7297_CR54","doi-asserted-by":"crossref","first-page":"3698","DOI":"10.1016\/j.ekir.2025.07.038","volume":"10","author":"C Bigatti","year":"2025","unstructured":"Bigatti C, Angeletti A, Kajana X, Caridi G, Cravedi P (2025) Daratumumab efficacy in steroid-resistant nephrotic syndrome correlates with CD38(+) B-cell depletion. Kidney Int Rep 10:3698\u20133700","journal-title":"Kidney Int Rep"},{"key":"7297_CR55","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/j.ekir.2022.03.002","volume":"7","author":"A Uffing","year":"2022","unstructured":"Uffing A, Hullekes F, Hesselink DA, Mansur JB, Malvezzi P, de Vries APJ, Seeger H, Manfro RC, Nissaisorakarn P, Wang AX, Reindl-Schwaighofer R, Sanchez-Russo L, Cravedi P, Riella LV, Berger SP (2022) Long-term apheresis in the management of patients with recurrent focal segmental glomerulosclerosis after kidney transplantation. Kidney Int Rep 7:1424\u20131427","journal-title":"Kidney Int Rep"},{"key":"7297_CR56","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1111\/j.1600-6143.2007.02021.x","volume":"8","author":"JM Yabu","year":"2008","unstructured":"Yabu JM, Ho B, Scandling JD, Vincenti F (2008) Rituximab failed to improve nephrotic syndrome in renal transplant patients with recurrent focal segmental glomerulosclerosis. Am J Transplant 8:222\u2013227","journal-title":"Am J Transplant"},{"key":"7297_CR57","doi-asserted-by":"crossref","DOI":"10.1111\/petr.14544","volume":"27","author":"JD Delbet","year":"2023","unstructured":"Delbet JD, Hogan J, Parmentier C, Ulinski T, Dossier C (2023) Successful global anti-B-cell strategy with daratumumab in a patient with post-transplant nephrotic syndrome recurrence unresponsive to immunoadsorption and obinutuzumab. Pediatr Transplant 27:e14544","journal-title":"Pediatr Transplant"},{"key":"7297_CR58","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.ajt.2023.12.010","volume":"24","author":"A Angeletti","year":"2024","unstructured":"Angeletti A, Bin S, Magnasco A, Bruschi M, Cravedi P, Ghiggeri GM (2024) Efficacy of combined rituximab and daratumumab treatment in posttransplant recurrent focal segmental glomerulosclerosis. Am J Transplant 24:688\u2013692","journal-title":"Am J Transplant"},{"key":"7297_CR59","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1016\/j.ajt.2024.06.010","volume":"24","author":"P Randone","year":"2024","unstructured":"Randone P, Sanna E, Dolla C, Gallo E, Mingozzi S, Tarragoni R, Torazza MC, Niarchos A, Mella A, Manzione AM, Barreca A, Deambrosis I, Giraudi R, Biancone L (2024) Rescue with obinutuzumab and daratumumab as combined B cell\/plasma cell targeting approach in severe posttransplant focal segmental glomerulosclerosis recurrence. Am J Transplant 24:1896\u20131900","journal-title":"Am J Transplant"},{"key":"7297_CR60","volume":"25","author":"J Martin","year":"2024","unstructured":"Martin J, Cheng Q, Laurent SA, Thaler FS, Beenken AE, Meinl E, Kr\u00f6nke G, Hiepe F, Alexander T (2024) B-cell maturation antigen (BCMA) as a biomarker and potential treatment target in systemic lupus erythematosus. Int J Mol Sci 25:10845","journal-title":"Int J Mol Sci"},{"key":"7297_CR61","doi-asserted-by":"crossref","unstructured":"Moszczuk B, Mucha K, Kucharczyk R, Zagozdzon R (2025) The role of glomerular and serum expression of lymphocyte activating factors BAFF and APRIL in patient with membranous and IgA nephropathies. Arch Immunol Ther Exp (Warsz) 73(1)","DOI":"10.2478\/aite-2025-0018"},{"key":"7297_CR62","doi-asserted-by":"publisher","first-page":"3513","DOI":"10.1007\/s00467-025-06884-1","volume":"40","author":"I Guzzo","year":"2025","unstructured":"Guzzo I, Becilli M, Cappoli A, Merli P, Labbadia R, Del Bufalo F, Tomas NM, Colucci M, Huber TB, Algeri M, Andreani M, Emma F, Locatelli F (2025) Anti-CD19 chimeric antigen receptor T-cell therapy in a highly sensitized patient with focal and segmental glomerulosclerosis. Pediatr Nephrol 40:3513\u20133519","journal-title":"Pediatr Nephrol"},{"key":"7297_CR63","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.1038\/s41591-022-02017-5","volume":"28","author":"A Mackensen","year":"2022","unstructured":"Mackensen A, M\u00fcller F, Mougiakakos D, B\u00f6ltz S, Wilhelm A, Aigner M, V\u00f6lkl S, Simon D, Kleyer A, Munoz L, Kretschmann S, Kharboutli S, Gary R, Reimann H, R\u00f6sler W, Uderhardt S, Bang H, Herrmann M, Ekici AB, Buettner C, Habenicht KM, Winkler TH, Kr\u00f6nke G, Schett G (2022) Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus. Nat Med 28:2124\u20132132","journal-title":"Nat Med"}],"container-title":["Pediatric Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-026-07297-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-026-07297-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-026-07297-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:54:28Z","timestamp":1792104868000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-026-07297-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,18]]},"references-count":63,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["7297"],"URL":"https:\/\/doi.org\/10.1007\/s00467-026-07297-4","relation":{},"ISSN":["0931-041X","1432-198X"],"issn-type":[{"value":"0931-041X","type":"print"},{"value":"1432-198X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,18]]},"assertion":[{"value":"20 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}