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Q:
My son has FSGS. In the last 15 years he has had frequent relapses. Last year he relapsed on WYSOLONE. When he relapsed in last month, the doctor prescribed WYSOLONE for 15 days and the ALBUMIN down from +4 to negative. Now it seems that he has become dependent on steroids and the medicines are not working for him. This time Dr. suggested him. MABTHERA 500mg. I am wondering about the future for this kind of treatment. I also want to know whether kidney transplant is possible or not in my case. Would you please answer me:
1. Whether two doses of MEBTHERA 500mg should be given or not.
2. Possibility of kidney transplant.
3. How long more will the treatment require?
4. How long to live for my son?
5. Is other treatment possible?
A:
MABTTHERA is a kind of immunosuppressive medicine, the targeted effect of which is to quiet the immune system and slow inflammation within the kidneys. Previously used medicines as what you have mentioned has similar effect, it is but that MABTHERA has a stronger effect. FSGS is overactive inflammatory damage to glomerular cells. This kind of exceeding inflammation occurs when the immune system gets disordered, abnormally activated due to some abnormalities---known as antibody-antigen complexes (immune complex) are deposited on kidney tissues. Glomerular cells are filtering structure of the kidneys responsible for preventing proteins from escaping into urine. When glomerular filtering cells are impaired, an excess protein will be present in urine.
Immunosuppressive medicines are commonly applied in treatment of FSGS. Those medicines are targeted to inactivate the inflammation, thus relieving symptoms and delaying deterioration of kidney condition. However, it should be noted that clear immune diagnosis is important before the treatment. This means doctors will need to confirm the extent of immune response activation, immune status, degrees of kidney damage. On this basis the medicines prescribed will meet the real condition and stop the inflammation. During the immune suppression treatment, regular immune condition re-checkups are essential to make sure whether the condition is controlled well, adjust medicine dose if needed, and achieve long-term target to stop the disease from recurring. This treatment process referred as immune blocking by doctors. It is a technique not easy to be controlled—in case blocking treatment is applied inappropriately, the disease may likely to recur.
MABTHERA, as is mentioned, has a much stronger effect in suppressing the overactive immune response than other medicines. So it is often applied to treat those suffering from refractory or uncontrollable kidney diseases. Like other types of kidney disorders, relapses are dangerous for FSGS, because frequent relapses can speed up deterioration of kidney damage. Kidney transplant is less likely in FSGS with kidney failure. According to researches, after transplantation, FSGS patients have 17% to 50% chances of having their disease recurring. This may be associated to heavy use of immunosuppressive medicine and immune basis of FSGS.
