Evidence map›Paper›PMID 41843217›Full record

SynthesisEuropean journal of pediatrics2026

Rituximab-induced hypogammaglobulinemia in childhood nephrotic syndrome: a systematic review and meta-analysis.

Jason Chung, Zinnia Chung, Andrew Yu, Cal Robinson, Joycelyne Ewusie, Andrew M South, Arvind Bagga, Abdulaziz Bamhraz, Rajiv Sinha, Rauda AlKhoori and 2 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Jason ChungDepartment of Internal Medicine, University of Western Ontario, London, Ontario, Canada.
Zinnia ChungMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Andrew YuFaculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Cal RobinsonDivision of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Joycelyne EwusieDepartment of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada.
Andrew M SouthSection of Nephrology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
Arvind BaggaDivision of Nephrology, Department of Pediatrics, India Institute of Medical Sciences, New Delhi, India.
Abdulaziz BamhrazDivision of Nephrology, Cumming School of Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada.
Rajiv SinhaDivision of Paediatric Nephrology, Institute of Child Health, Kolkata, India.
Rauda AlKhooriDepartment of Internal Medicine, University of Toronto, Toronto, Ontario, Canada.
Yuanxin XueTemerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Rahul ChanchlaniDivision of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, 1280 Main St W., Hamilton, ON, L8N 3Z5, Canada. chanchlr@mcmaster.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome (e.g., steroid-dependent or frequently relapsing disease). Post-rituximab hypogammaglobulinemia is a recognized adverse effect that may predispose to severe, including fatal, infections. We conducted a systematic review to estimate the incidence proportion of hypogammaglobulinemia after rituximab and the frequency of concomitant infections in children with nephrotic syndrome. We conducted a systematic review of five databases (1974-2024) for English-language studies enrolling children with nephrotic syndrome who received ≥ 1 dose of rituximab. Hypogammaglobulinemia was defined as an IgG concentration > 2 SD below the age-specific reference value. Of 2681 screened publications, 33 were eligible for meta-analysis. The pooled incidence of hypogammaglobulinemia in children with nephrotic syndrome receiving rituximab was 11.4% (95% CI, 6.4, 19.5). Patients who received rituximab were at increased risk of hypogammaglobulinemia with a risk ratio of 1.81 (95% CI, 1.46, 2.25; equivalent to 68 additional cases per 1000 patients). In 517 episodes of hypogammaglobulinemia, 93 (18%) infections occurred, four of which were fatal.

conclusionHypogammaglobulinemia is a common side effect of rituximab that can result in life-threatening infections. The risk of hypogammaglobulinemia and infections should be weighed against the effectiveness of rituximab for nephrotic syndrome management. Prospero registration: CRD42024536465. WHAT IS KNOWN: • Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome. • Post-rituximab hypogammaglobulinemia is a recognized adverse effect that may predispose to severe, including fatal, infections; however, the magnitude of risk of poorly understood in pediatric population. WHAT IS NEW: • The pooled incidence of hypogammaglobulinemia in children with nephrotic syndrome receiving rituximab was 11.4%. Rituximab exposure was associated with a significantly higher risk of hypogammaglobulinemia compared with children not receiving rituximab (risk ratio 1.81). • In 517 episodes of hypogammaglobulinemia, 93 (18%) infections occurred, four of which were fatal.

Indexed as

AgammaglobulinemiaImmunologic FactorsNephrotic SyndromeRituximabChildChild, PreschoolHumansIncidenceImmunologic FactorsRituximabAdverse reactionHypogammaglobulinemiaImmunoglobulinNephrotic syndromePediatricRituximab

Identifiers

PMID41843217

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.