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Rituximab refractory PLA2R positive membranous glomerulonephritis
A 53-year-old man who has nephrotic syndrome (12 grams) and multiple thromboses and a PLA2R level >1500 receives two 1 gram doses of rituximab. Four months later his PLA2R is down to 800 but his proteinuria is unchanged. By six months his PLA2r is back to >1500 and his proteinuria is now 21 grams. What would you do next? Share your thoughts.

Summary provided by Roger Rodby, MD, FASN.
Previous Community Minded Summaries are available at: https://community.asn-online.org/browse/communityminded