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How can renal dysfunction be treated in patients with thalassaemia?

Q: My 24 years old niece is a patient of thalassaemia major and has to undergo blood transfusion and desferal medication. Now she is suffering from kidney ailment. Her kidneys are losing proteins. The doctor has prescribed a 4 injections course of Ritruximab 500 mg, which appears to be the brand name. What is the name of the medical name of this medicine? Is this treatment effective?

A:Renal dysfunction in thalassemia patients can be attributed to chronic anaemia, and iron overload as well as to desferioxamine (DFO) toxicity. Rituximab is a chimeric monoclonal antibody directed against CD20 antigen, a transmembrane protein, is found on immature and mature B cells, as well as on malignant B cells. Rituximab affects production of antibodies and regulation of immunoglobulin maturation by B cells includes reduced levels of IgM (variable), rheumatoid factor and autoantibodies. Its use in kidney disease has been in the setting of post transplant, vasculitis, SLE, idiopathic membranous nephropathy and studies have shown a significant reduction in the protein loss. Assuming that your nephrologist considers the protein loss and abnormal kidney function in your patient related to an immune based dysfunction, the therapy with anti CD20 might help. However, one needs to know that per se the role of rituximab in renal dysfunction in thalassemia patients is still under a lot of debate. While there are some studies for it there are many other, which are against.


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