[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-443109-105":59,"doc-detail-443109-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","recurrent-igg4-related-tubulointerstitial-nephritis-successfully-treated-with-obinutuzumab-a-case-report-and-literature-review","Recurrent IgG4-related Tubulointerstitial Nephritis Successfully Treated With Obinutuzumab - A Case Report and Literature Review","","Recurrent IgG4-related tubulointerstitial nephritis following relapse after glucocorticoid tapering is presented with treatment escalation to obinutuzumab. The report describes a 51-year-old woman with persistent elevations of serum creatinine, IgG4, and proteinuria, alongside recurrent rash and pulmonary involvement, initially controlled with methylprednisolone. After relapse in 2023, obinutuzumab induction and prednisone tapering achieved rapid clinical improvement, normalization of renal function, urine protein, and serum IgG4, and sustained B-cell depletion. A 15-month follow-up showed stable renal outcomes and continued biochemical remission despite intermittent respiratory symptoms.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/recurrent-igg4-related-tubulointerstitial-nephritis-successfully-treated-with-obinutuzumab-a-case-report-and-literature-review/443109/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/recurrent-igg4-related-tubulointerstitial-nephritis-successfully-treated-with-obinutuzumab-a-case-report-and-literature-review/443109.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why was obinutuzumab chosen after relapse in IgG4-TIN?","Question",{"text":113,"@type":114},"The report notes that glucocorticoids can have suboptimal remission and that recurrence remains high after rituximab-based therapy. Obinutuzumab was used after relapse to provide an alternative strategy for IgG4-RD treatment.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What evidence confirmed IgG4-related tubulointerstitial nephritis in the patient?",{"text":118,"@type":114},"The diagnosis was confirmed by renal biopsy showing IgG4-TIN, along with elevated serum IgG4, proteinuria, and kidney function impairment. The IgG4-RD responder index was also reported.",{"name":120,"@type":111,"acceptedAnswer":121},"What outcomes were observed after obinutuzumab induction and maintenance?",{"text":122,"@type":114},"After treatment, the rash subsided, cough improved, renal function normalized, and both urine protein and serum IgG4 returned to normal. During 15-month follow-up, renal function and biochemical remission remained stable, with intermittent respiratory symptoms.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},443109,1791027813,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","Case Report  \nRecurrent IgG4-related Tubulointerstitial Nephritis Successfully Treated With Obinutuzumab: A Case Report and Literature Review  \nShu-Hua Zhu, * Du-Qun Chen, * Ming-Chao Zhang, Zhe Li, and Zhen Cheng  \nCurrently, Immunoglobulin G4 (IgG4)–related disease is treated with glucocorticoids alone or in combination with other immunosuppressants. Although the initial response rate is substantial, the remission rate is suboptimal, and the recurrence rate following rituximab therapy remains high. Here, we report the first patient with IgG4-related tubulointerstitial nephritis who was treated with obinutuzumab after relapse, providing additional insights for future treatment strategies. This case demonstrates that the obinutuzumab induction and maintenance regimen in patients with IgG4-related tubulointerstitial nephritis can maintain prolonged B-cell depletion, rapidly and persistently reduce inflammation and serum IgG4 levels, and reverse functional impairment in some affected organs.  \n© 2025 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)).  \nComplete author and article information provided before references.  \nCorrespondence to Z. Li ([lizhe_doctor@163.com](lizhe_doctor@163.com)) or Z. Cheng (chengzhen33@ [hotmail.com](hotmail.com))  \n*S.H.Z. and D. Q. C. contributed equally to this work.  \nKidney Med. 8(1):101156. Published online October 23, 2025.  \ndoi: 10.1016/j. xkme.2025.101156  \nImmunoglobulin G4 (IgG4)–related disease (IgG4-RD) is  \na relatively uncommon immune-mediated chronic inflammatory disease that potentially affects multiple organs and systems. Renal involvement typically manifests astubulointerstitial nephritis, with a minority of patients exhibiting glomerular lesions primarily characterized by proteinuria. In severe cases, this can lead to acute or chronic renal insufficiency. 1 Currently, glucocorticoids (GCs), either as monotherapies or in combination with other immunosuppressants, demonstrate high efficacy, yet the remission rate remains suboptimal.2 Rituximab (RTX) is utilized in IgG4-RD patients who do not respond to conventional therapy, who relapse during GC tapering, or who exhibit GC resistance or intolerance.3 However, longterm follow-up indicates a persistently high recurrence rate with this regimen.4 Here, we report a case of IgG4-related tubulointerstitial nephritis (IgG4-TIN) in which obinutuzumab was administered following relapse, offering additional insights for future treatment strategies in IgG4-RD.  \nCase Report  \nA 51-year-old woman patient was admitted in September 2023 with a history of intermittent rash and elevated serum creatinine (Scr) and globulin levels for 3 years. Three years prior, she developed a dark red rash on both lower limbs without pruritus, abdominal pain, bloody stool, or joint pain. The rash resolved spontaneously within 3-4 days but recurred frequently. Laboratory tests revealed a serum immunoglobulin G level of 92.9 g/L, an IgG4 level of 38,400 mg/L, positive urinary proteinuria, and a Scr level of 202 μmol/L, leading to a diagnosis of IgG4-RD. She was treated with methylprednisolone at 24 mg/d, which led to the resolution of the rash and a  \ndecrease in Scr to 96 μmol/L, although her IgG4 level remained elevated. Methylprednisolone was gradually tapered over 2 years. In early August 2023, her Scr was 187.5 μmol/L, and her urine protein was 0.31 g/24 h. Two weeks later, she experienced large red rashes on her limbs with pruritus, irritant cough, and chest distress, which occurred 3-4 times daily. A bronchodilation test was positive, indicating mixed pulmonary ventilation dysfunction (Fig 1A) . Computed tomography revealed bilateral pneumonia, with multiple enlarged lymph nodes in the bilateral hilar regions, supraclavicular fossae, axillary regions, and mediastinum. (Fig 2","cbCaioRqiRZnaNc2","https://ap.wps.com/l/cbCaioRqiRZnaNc2","pdf",5670409,"English","# Case Report\n## Background and rationale\n## Patient presentation and diagnosis\n## Treatment course and follow-up","[{\"question\":\"Why was obinutuzumab chosen after relapse in IgG4-TIN?\",\"answer\":\"The report notes that glucocorticoids can have suboptimal remission and that recurrence remains high after rituximab-based therapy. Obinutuzumab was used after relapse to provide an alternative strategy for IgG4-RD treatment.\"},{\"question\":\"What evidence confirmed IgG4-related tubulointerstitial nephritis in the patient?\",\"answer\":\"The diagnosis was confirmed by renal biopsy showing IgG4-TIN, along with elevated serum IgG4, proteinuria, and kidney function impairment. The IgG4-RD responder index was also reported.\"},{\"question\":\"What outcomes were observed after obinutuzumab induction and maintenance?\",\"answer\":\"After treatment, the rash subsided, cough improved, renal function normalized, and both urine protein and serum IgG4 returned to normal. During 15-month follow-up, renal function and biochemical remission remained stable, with intermittent respiratory symptoms.\"}]","Recurrent IgG4-related Tubulointerstitial Nephritis Successfully Treated With Obinutuzumab - A Case Report and Literature Review | PDF",1790702941,15]