Evidence map›Paper›PMID 42435047›Full record

ArticlePediatric nephrology (Berlin, Germany)2026

Hypogammaglobulinemia and B cell repopulation after rituximab in childhood nephrotic syndrome.

Cal H Robinson, Sophia Gorgiev, Nowrin Aman, Tonny H M Banh, Josefina Brooke, Valentina Bruno, Vaneet Dhillon, Mackenzie Garner, Christoph Licht, Ashlene McKay and 8 more

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Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

18 authors.

Cal H RobinsonDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada. cal.robinson@sickkids.ca.ORCID http://orcid.org/0000-0002-2223-0646
Sophia GorgievChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada.
Nowrin AmanChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada.
Tonny H M BanhChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada.
Josefina BrookeDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Valentina BrunoDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Vaneet DhillonDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Mackenzie GarnerChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada.
Christoph LichtDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Ashlene McKayDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Damien NooneDepartment of Pediatrics, Division of Nephrology, University of Alberta, Edmonton, AB, Canada.
Rachel PearlDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Seetha RadhakrishnanDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Keisha RasoolDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Nithiakishna SelvathesanDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Chia Wei TeohDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Jovanka Vasilevska-RistovskaChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada.
Rulan S ParekhDepartment of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRituximab is increasingly used to treat childhood nephrotic syndrome, although its long-term effects are poorly understood. Our study aims to evaluate the incidence and risk factors for hypogammaglobulinemia, hematological complications, B cell repopulation, and relapses after rituximab treatment.

methodsWe included children (1-18 years of age) with nephrotic syndrome who were enrolled in a prospective cohort study (Greater Toronto Area, Canada) and received rituximab from June 2018 to December 2023. We collected all immunoglobulin, hematology, and microbiology results from our institution. The primary outcome was hypogammaglobulinemia (IgG ≥ 2 standard deviations below the age-specific mean), classified as severe (IgG < 3 g/L) and/or prolonged (≥ 12 months). Secondary outcomes included other immunoglobulin and hematological parameters, B cell depletion, and relapses.

resultsSeventy children with nephrotic syndrome received rituximab treatment. Pre-existing hypogammaglobulinemia was present in 46% of the patients. After rituximab, 68% of the patients had any, 32% had severe, and 46% had prolonged hypogammaglobulinemia. Younger age (odds ratio [OR] 1.13, 95% CI 1.01-1.29), European ethnicity (OR 6.37, 95% CI 1.74-30.83), lower pre-treatment IgG (OR 1.63, 95% CI 1.24-2.31) and longer maintenance immunosuppression duration (OR 1.27, 95% CI 1.03-1.61) were risk factors for prolonged hypogammaglobulinemia post-rituximab. Post-rituximab, 16% of the children had anemia, 21% had neutropenia, and 3% had thrombocytopenia. Twelve children (17%) developed documented infections. All children experienced complete B cell depletion post-rituximab, with B cell repopulation at median 6.3 months. Older age, prior calcineurin inhibitor treatment, and steroid sensitivity were associated with longer time-to-B cell repopulation.

conclusionsProlonged hypogammaglobulinemia occurs in half of children with nephrotic syndrome post-rituximab. Younger age, European ethnicity, lower pre-treatment IgG, and longer maintenance immunosuppression use are associated with higher prolonged hypogammaglobulinemia risk.

Indexed as

B cell depletionChildrenHypogammaglobulinemiaNephrotic syndromeRituximab

Identifiers

PMID42435047

What Socratic holds

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Registered trials

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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.