{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:55:13Z","timestamp":1778770513080,"version":"3.51.4"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Minimal change disease (MCD) is one of the common causes of idiopathic nephrotic syndrome (INS), accounting for 10\u201320% of INS in adults. Glucocorticoids are the most commonly used and effective drugs in the treatment of MCD, but there is still a proportion of adult patients with MCD who are characterized by glucocorticoid resistance, glucocorticoid dependence, and frequent relapse, which are defined as refractory nephrotic syndrome. Glucocorticoid combination with immunosuppressants is frequently used in patients with refractory nephrotic syndrome, and patients concerned about adverse effects caused by long-term high-dose glucocorticoid therapy. Recent studies have suggested that Rituximab (RTX), a chimeric monoclonal antibody targeted against the pan-B-cell marker CD20, combined with a small or medium dose of glucocorticoid has a beneficial effect with less adverse effects on adult patients with refractory MCD. \u03b2-thalassemia is an inherited hemoglobulin disorder caused by the mutation of genes that encode \u03b2-globin and results in ineffective erythropoiesis. We here report a case of an adult patient with refractory MCD complicated with \u03b2-thalassemia minor accompanied by autoimmune hemolytic anemia (AIHA). MCD relapsed several times despite treatment using glucocorticoid combined with or without different immunosuppressive agent regimens. The \u03b2-thalassemia minor was caused by heterozygosity for a 4-base deletion mutation [codons 41\/42 (\u2212TTCT) BETA<jats:sup>0<\/jats:sup>] of the \u03b2-globin gene. After the administration of RTX, MCD achieved clinical complete remission, and the anemia due to mild \u03b2-thalassemia recovered to normal as well. The disease situation remained stable during 36 months of follow-up. These findings suggest that RTX may contribute to the improvement of refractory MCD and anemia in \u03b2-thalassemia minor accompanied by AIHA.<\/jats:p>","DOI":"10.3389\/fmed.2022.1059740","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T07:27:03Z","timestamp":1667460423000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Case report: Successful outcome of treatment using rituximab in an adult patient with refractory minimal change disease and \u03b2-thalassemia complicating autoimmune hemolytic anemia"],"prefix":"10.3389","volume":"9","author":[{"given":"Jing","family":"Zhuang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhigang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changrong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuefei","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"445","DOI":"10.2215\/CJN.03531006","article-title":"Adult minimal-change disease: clinical characteristics, treatment, and outcomes","volume":"2","author":"Waldman","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1093\/ndt\/gfw021","article-title":"Targeting the podocyte cytoskeleton: from pathogenesis to therapy in proteinuric kidney disease.","volume":"31","author":"Tian","year":"2016","journal-title":"Nephrol Dial Transplant."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.4103\/imna.imna_26_21","article-title":"New insights into the immunity and podocyte in glomerular health and disease: from pathogenesis to therapy in proteinuric kidney disease.","volume":"8","author":"Medina Rangel","year":"2021","journal-title":"Integr Med Nephrol Androl."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/1710-1492-9-30","article-title":"A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.","volume":"9","author":"Liu","year":"2013","journal-title":"Allergy Asthma Clin Immunol."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.22313","article-title":"Rituximab for steroid-dependent minimal change disease in adults: is it time for a change?","volume":"14","author":"Kannan","year":"2022","journal-title":"Cureus."},{"key":"B6","doi-asserted-by":"publisher","first-page":"F1000FacultyRev","DOI":"10.12688\/f1000research.7300.1","article-title":"Cell biology and genetics of minimal change disease.","volume":"5","author":"Saleem","year":"2016","journal-title":"F1000Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1111\/j.1365-2141.1983.tb02041.x","article-title":"Thalassaemia intermedia in cyprus: the interaction of alpha and beta thalassaemia.","volume":"53","author":"Wainscoat","year":"1983","journal-title":"Br J Haematol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"480","DOI":"10.2471\/BLT.06.036673","article-title":"Global epidemiology of haemoglobin disorders and derived service indicators.","volume":"86","author":"Modell","year":"2008","journal-title":"Bull World Health Organ."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.692727","article-title":"Case report: the monogenic familial steroid-resistant nephrotic syndrome caused by a novel missense mutation of NPHS2 gene A593C in a Chinese family.","volume":"9","author":"Bai","year":"2021","journal-title":"Front Pediatr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.kint.2021.05.015","article-title":"Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases.","volume":"100","author":"Rovin","year":"2021","journal-title":"Kidney Int."},{"key":"B11","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jaut.2017.10.006","article-title":"NEPHRUTIX: a randomized, double-blind, placebo vs rituximab-controlled trial assessing T-cell subset changes in minimal change nephrotic syndrome.","volume":"88","author":"Boumediene","year":"2018","journal-title":"J Autoimmun."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102671","article-title":"Rituximab in adult minimal change disease and focal segmental glomerulosclerosis - What is known and what is still unknown?","volume":"19","author":"Gauckler","year":"2020","journal-title":"Autoimmun Rev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1053\/j.seminhematol.2010.01.011","article-title":"Rituximab: mechanism of action.","volume":"47","author":"Weiner","year":"2010","journal-title":"Semin Hematol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1111\/imr.12859","article-title":"The role of B cell antigen presentation in the initiation of CD4+ T cell response.","volume":"296","author":"Hua","year":"2020","journal-title":"Immunol Rev."},{"key":"B15","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1159\/000486930","article-title":"Rituximab as a therapeutic option for steroid-sensitive minimal change nephrotic syndrome in adults.","volume":"195","author":"Iwabuchi","year":"2018","journal-title":"Contrib Nephrol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1093\/ndt\/gfu209","article-title":"Rituximab for minimal-change nephrotic syndrome in adulthood: predictive factors for response, long-term outcomes and tolerance.","volume":"29","author":"Guitard","year":"2014","journal-title":"Nephrol Dial Transplant."},{"key":"B17","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1111\/nep.12744","article-title":"Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease.","volume":"21","author":"Papakrivopoulou","year":"2016","journal-title":"Nephrology."},{"key":"B18","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1681\/ASN.2021060794","article-title":"Discovery of autoantibodies targeting nephrin in minimal change disease supports a novel autoimmune etiology.","volume":"33","author":"Watts","year":"2022","journal-title":"J Am Soc Nephrol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1681\/ASN.2011030304","article-title":"Basic and translational concepts of immune-mediated glomerular diseases.","volume":"23","author":"Couser","year":"2012","journal-title":"J Am Soc Nephrol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.ekir.2017.09.011","article-title":"Nephrin loss can be used to predict remission and long-term renal outcome in patients with minimal change disease.","volume":"3","author":"van de Lest","year":"2018","journal-title":"Kidney Int Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1096\/fj.201600618R","article-title":"Sphingomyelinase-like phosphodiesterase 3b mediates radiation-induced damage of renal podocytes.","volume":"31","author":"Ahmad","year":"2017","journal-title":"FASEB J."},{"key":"B22","doi-asserted-by":"publisher","first-page":"332","DOI":"10.2215\/CJN.05000516","article-title":"Minimal change disease.","volume":"12","author":"Vivarelli","year":"2017","journal-title":"Clin J Am Soc Nephrol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1111\/trf.12348","article-title":"Transfusion complications in thalassemia patients: a report from the Centers for Disease Control and Prevention (CME).","volume":"54","author":"Vichinsky","year":"2014","journal-title":"Transfusion."},{"key":"B24","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s12185-021-03173-z","article-title":"Prevalence and molecular spectrum of alpha- and beta-globin gene mutations in Hainan, China.","volume":"114","author":"Wang","year":"2021","journal-title":"Int J Hematol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1182\/blood-2018-06-818187","article-title":"How I manage medical complications of beta-thalassemia in adults.","volume":"132","author":"Taher","year":"2018","journal-title":"Blood."},{"key":"B26","doi-asserted-by":"publisher","first-page":"261","DOI":"10.12932\/AP0426.32.3.2014","article-title":"Phenotypic characterization of circulating CD4\/CD8 T-lymphocytes in beta-thalassemia patients.","volume":"32","author":"Noulsri","year":"2014","journal-title":"Asian Pac J Allergy Immunol."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22189677","article-title":"Pathomechanisms of Immunological Disturbances in beta-Thalassemia.","volume":"22","author":"Gluba-Brzozka","year":"2021","journal-title":"Int J Mol Sci."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a011726","article-title":"Pathophysiology and clinical manifestations of the beta-thalassemias.","volume":"2","author":"Nienhuis","year":"2012","journal-title":"Cold Spring Harb Perspect Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1159\/000439002","article-title":"New insights in the pathogenesis of autoimmune hemolytic anemia.","volume":"42","author":"Barcellini","year":"2015","journal-title":"Transfus Med Hemother."},{"key":"B30","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3109\/08880018.2012.666782","article-title":"Autoimmune hemolytic anemia in patients with beta-thalassemia major.","volume":"29","author":"Xu","year":"2012","journal-title":"Pediatr Hematol Oncol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1059740\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T07:27:05Z","timestamp":1667460425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1059740\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,3]]},"references-count":30,"alternative-id":["10.3389\/fmed.2022.1059740"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.1059740","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,3]]},"article-number":"1059740"}}