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On September 28 — October 1, 2023, the European Society for Paediatric Nephrology (ESPN) 55th Annual Meeting was held in Vilnius, Lithuania, where new achievements in the world of pediatric nephrology were presented. The program included 66 sessions with reports, continuing medical education courses, 117 invited speakers, meetings of working groups on various issues of pediatric nephrology were held, about 450 abstracts were printed and 292 poster presentations were discussed, inclu­ding two by authors from Ukraine. Courses for young doctors, preparing them for the international exam, and 5-minute reports by well-known specialists became interesting in the organization of continuing medical education, which significantly increased the amount of presented material. Among the innovative approaches in pediatric nephrology, the following drugs have been considered: finerenone (a selective non-steroidal mineralocorticoid receptor antagonist), sparsentan (an angiotensin/endothelin receptor antagonist) for Alport syndrome, focal segmental glomerulosclerosis, IgA nephropathy, dapagliflozin (a sodium-glucose cotransporter 2 inhibitor) for chronic kidney disease and pioglitazone for proteinuria. New approaches have been introduced: to IgA nephropathy — proteinuria control with angiotensin-converting enzyme inhibitors (ACEi), tonsillectomy, rituximab, eculizumab; to focal segmental glomerulosclerosis — plasmapheresis, rituximab (CD20), ofatumumab (CD20), abatacept (CD80/86), belatacept (CD80/86), daratumumab (CD38); to membranous nephropathy — proteinuria control with ACEi, rituximab, calcineurin inhibitors, glucocorticoids, cyclophosphamide; to membranoproliferative glomerulonephritis — proteinuria control with ACEi; to C3 glomerulopathy — proteinuria control with ACEi, eculizumab. Specific provisions of the BK polyomavirus (BKPyV) guidelines were considered, in particular, monthly screening for BKPyV-DNAemia in blood plasma is suggested until month 9, then every 3 months until month 24, after which additional screening every 3 months until the end of the third year after transplantation in pediatric kidney recipients (C, weak). In pediatric patients with stable renal function and high BKPyV-DNAemia, despite reduction in immunosuppressive therapy, we suggest consideration of renal allograft biopsy, as creatinine elevation may be decreased in children with significant renal involvement, including rejection (A, strong).

On September 28 — October 1, 2023, the European Society for Paediatric Nephrology (ESPN) 55th Annual Meeting was held in Vilnius, Lithuania, where new achievements in the world of pediatric nephrology were presented. The program included 66 sessions with reports, continuing medical education courses, 117 invited speakers, meetings of working groups on various issues of pediatric nephrology were held, about 450 abstracts were printed and 292 poster presentations were discussed, including two by authors from Ukraine. Courses for young doctors, preparing them for the international exam, and 5-minute reports by well-known specialists became interesting in the organization of continuing medical education, which significantly increased the amount of presented material. Among the innovative approaches in pediatric nephrology, the following drugs have been considered: finerenone (a selective non-steroidal mineralocorticoid receptor antagonist), sparsentan (an angiotensin/endothelin receptor antagonist) for Alport syndrome, focal segmental glomerulosclerosis, IgA nephropathy, dapagliflozin (a sodium-glucose cotransporter 2 inhibitor) for chronic kidney disease and pioglitazone for proteinuria. New approaches have been introduced: to IgA nephropathy — proteinuria control with angiotensin-converting enzyme inhibitors (ACEi), tonsillectomy, rituximab, eculizumab; to focal segmental glomerulosclerosis — plasmapheresis, rituximab (CD20), ofatumumab (CD20), abatacept (CD80/86), belatacept (CD80/86), daratumumab (CD38); to membranous nephropathy — proteinuria control with ACEi, rituximab, calcineurin inhibitors, glucocorticoids, cyclophosphamide; to membranoproliferative glomerulonephritis — proteinuria control with ACEi; to C3 glomerulopathy — proteinuria control with ACEi, eculizumab. Specific provisions of the BK polyomavirus (BKPyV) guidelines were considered, in particular, monthly screening for BKPyV-DNAemia in blood plasma is suggested until month 9, then every 3 months until month 24, after which additional screening every 3 months until the end of the third year after transplantation in pediatric kidney recipients (C, weak). In pediatric patients with stable renal function and high BKPyV-DNAemia, despite reduction in immunosuppressive therapy, we suggest consideration of renal allograft biopsy, as creatinine elevation may be decreased in children with significant renal involvement, including rejection (A, strong). [ABSTRACT FROM AUTHOR]

Nephrotic syndrome (NS) is a common glomerular pathology encountered in pediatric practice. The main clinical signs are massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Among all cases of NS, 75 % of children have a histological variant of glomerular lesions in the form of minimal change di­sease that is sensitive to hormone therapy, but easily leads to relapse and steroid dependence. These children often need to extend the time of taking hormonal drugs or add other immunosuppressants, which can have significant toxicity. Available immunosuppressant treatment options include cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. The use of rituximab is a possible alternative treatment for steroid-dependent nephrotic syndrome in children. However, the efficacy and safety of ritu­ximab in the treatment of childhood steroid-dependent nephrotic syndrome is still controversial. The purpose was to evaluate the efficacy and safety of rituximab treatment in a child with steroid-dependent nephrotic syndrome on the example of a clinical case from our own practice.

Materials and methods. The article presents the data on the analysis of case histories in 16 children with glomerulopathies who received treatment with rituximab in accordance with the diagnoses. Age of patients was 5 to 18 years, distribution by sex — 5 boys (31.3 %), 11 girls (68.8 %). Twelve children (75 %) received rituximab for frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and 4 (25 %) children for lupus nephritis. Results. In some cases, rituximab was prescribed against the background of glucocorticoids per os. Rituximab therapy followed a protocol with pre-administration of 1 mg/kg methylprednisolone or 100 mg hydrocortisone, followed by 15 mg/kg rituximab at a rate of approximately 50 ml/h using an infusion pump, which had previously been diluted with saline 1 mg/ml, with constant monitoring of the child’s condition. Rituximab was administered at least twice, two weeks apart. If necessary, after monitoring the level of CD20 in the blood serum, and in the presence of any number of cells or the preservation of the activity of the process, rituximab was administered again 6 months after the last injection. During treatment with rituximab, children who received glucocorticoids per os did not receive them, and the next day after the infusion they continued to receive them at the same dose. Nine children received concomitant therapy per os with an angiotensin-converting enzyme inhibitor at a renoprotective dose, which was not canceled on the days of ritu­ximab infusion. During the administration of rituximab, two children reported adverse reactions in the form of a decreased blood pressure and tachycardia, which most likely occurred against the background of an increased rate of administration, and after stopping the infusion and a subsequent decrease in its rate, they disappeared. All other children tolerated rituximab well. The effectiveness of rituximab therapy was evaluated by the level of proteinuria, which at the baseline averaged 4.0 g/l, and after rituximab infusion, it averaged 0.5 g/l. Conclusions. Today, in the conditions of martial law in Ukraine and limited resources, the use of rituximab opens new opportunities in the treatment of nephrological pathology in children, acting as an alternative to the long-term use of glucocorticoids, simplifying treatment and reducing the number of side effects, especially in children with FRNS/SDNS and pathology-mediated AT (lupus nephritis). However, it is important to adhere to the protocol for rituximab administration and especially the rate of administration due to frequent adverse infusion reactions.

Materials and methods. The article presents the data on the analysis of case histories in 16 children with glomerulopathies who received treatment with rituximab in accordance with the diagnoses. Age of patients was 5 to 18 years, distribution by sex — 5 boys (31.3 %), 11 girls (68.8 %). Twelve children (75 %) received rituximab for frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and 4 (25 %) children for lupus nephritis. Results. In some cases, rituximab was prescribed against the background of glucocorticoids per os. Rituximab therapy followed a protocol with pre-administration of 1 mg/kg methylprednisolone or 100 mg hydrocortisone, followed by 15 mg/kg rituximab at a rate of approximately 50 ml/h using an infusion pump, which had previously been diluted with saline 1 mg/ml, with constant monitoring of the child’s condition. Rituximab was administered at least twice, two weeks apart. If necessary, after monitoring the level of CD20 in the blood serum, and in the presence of any number of cells or the preservation of the activity of the process, rituximab was administered again 6 months after the last injection. During treatment with rituximab, children who received glucocorticoids per os did not receive them, and the next day after the infusion they continued to receive them at the same dose. Nine children received concomitant therapy per os with an angiotensin-converting enzyme inhibitor at a reno protective dose, which was not cancelled on the days of rituximab infusion. During the administration of rituximab, two children reported adverse reactions in the form of a decreased blood pressure and tachycardia, which most likely occurred against the background of an increased rate of administration, and after stopping the infusion and a subsequent decrease in its rate, they disappeared. All other children tolerated rituximab well. The effectiveness of rituximab therapy was evaluated by the level of proteinuria, which at the baseline averaged 4.0 g/l, and after rituximab infusion, it averaged 0.5 g/l. Conclusions. Today, in the conditions of martial law in Ukraine and limited resources, the use of rituximab opens new opportunities in the treatment of nephrological pathology in children, acting as an alternative to the long-term use of glucocorticoids, simplifying treatment and reducing the number of side effects, especially in children with FRNS/SDNS and pathology mediated AT (lupus nephritis). However, it is important to adhere to the protocol for rituximab administration and especially the rate of administration due to frequent adverse infusion reactions [ABSTRACT FROM AUTHOR]