Traitement d’induction des vascularites à ANCA: algorithme #CJNeph
Rituximab can work to induce remission in patients with mild to moderate kidney involvement, but we must still remember that it is equivalent to cyclophosphamide. The notion that we can relegate patients with a serum creatinine < 4.0 mg/dl to receive rituximab and corticosteroids is useful for clinical trial purposes, but it is inappropriate for practicing clinicians to apply this metric in real-world settings. For example, the rapidity with which eGFR declines at or near presentation, regardless of the actual value, is a guidepost that many seasoned clinicians would use to provide aggressive immunosuppression beyond rituximab. Even more importantly, we should not use rituximab, because we think it is a kinder and gentler immunosuppressant.