New hope for kids with tough kidney disease: obinutuzumab may replace steroids

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria:Diagnostic Criteria for Pediatric Primary Nephrotic Syndrome (PNS): Children aged 1 to 18 years who meet the following criteria: Edema: Prominent edema, typically gravitational, affecting the eyelids and lower limbs. Massive proteinuria: Defined as urine protein-to-creatinine ratio (UPCR) ≥ 200 mg/mmol or 24-hour urine protein ≥ 40 mg/m²·h. Hypoalbuminemia: Serum albumin commonly below 25 g/L. Hyperlipidemia: Such as elevated total cholesterol. Subtypes of Pediatric PNS: Steroid-sensitive nephrotic syndrome (SSNS) Steroid-resistant nephrotic syndrome (SRNS) SSNS can be further divided into steroid-dependent nephrotic syndrome (SDNS) and frequently relapsing nephrotic syndrome (FRNS), with the following definitions: SSNS: An important clinical subtype of PNS. Diagnostic criteria: patients receiving standard-dose prednisone or prednisolone (usually 1.5-2.0 mg/kg/day or 60 mg/m²/day, maximum 60 mg/day) achieve urine protein remission within 4 weeks. SDNS: Initial response to glucocorticoid therapy is good, with proteinuria remission within 4 weeks. At least two relapses occur during steroid tapering or within 14 days after discontinuation, including relapses during dose reduction. FRNS: Occurrence of three or more relapses within 12 months, or two or more relapses within 6 months. A relapse is defined as consecutive 3-day morning urine protein ≥ +++ by dipstick or UPCR ≥ 200 mg/mmol. SRNS: Failure to achieve remission after 4 weeks of full-dose glucocorticoid therapy (prednisone or prednisolone 60 mg/m²/day or 1.5-2 mg/kg/day, maximum 60 mg/day) following PNS diagnosis, with persistent proteinuria (consecutive 3-day urine protein ≥ +++ by dipstick or UPCR ≥ 200 mg/mmol). \- Exclusion Criteria: * Secondary PNS: Chronic kidney disease caused by underlying conditions such as Henoch-Schönlein purpura, systemic lupus erythematosus, hepatitis B, diabetes, hereditary nephritis, severe infections, tumors, or medications. Exclusion criteria: Patients with significant steroid-related adverse effects, intolerance to steroids, or contraindications to steroid therapy.