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International guidance supports early genetic testing and evaluation for rare infectious etiologies. When genetic and infectious causes are not identified, an immunologic mechanism may be suspected and anti-CD20 strategies are considered. This report evaluates obinutuzumab as a rescue approach in a 24-month-old boy with severe multidrug-resistant SRNS refractory to cyclosporin A and rituximab, documenting complete remission with sustained proteinuria resolution and no severe adverse effects after two doses.",{"@graph":69,"@context":122},[70,84,105],{"@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/successful-therapy-with-obinutuzumab-in-a-toddler-with-primary-multidrug-resistant-nephrotic-syndrome-case-report/461602/",{"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/successful-therapy-with-obinutuzumab-in-a-toddler-with-primary-multidrug-resistant-nephrotic-syndrome-case-report/461602.png","ImageObject",300,407,{"name":92,"@type":93},"PakDamar76","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is primary steroid-resistant nephrotic syndrome (SRNS) concerning in young children?","Question",{"text":112,"@type":113},"It is considered ominous because therapeutic options are limited and the prognosis can be poor. In very young patients, genetic etiologies are more probable and are often resistant to immunosuppressive therapy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What diagnostic steps are recommended when SRNS is identified in very young children?",{"text":117,"@type":113},"Thorough evaluation for infectious agents, including atypical causes, is mandatory, and early genetic testing is emphasized. Guidance also supports renal biopsy to distinguish genetic disease from immunologic causes that may respond to intensified immunosuppression.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment regimen and outcome were reported with obinutuzumab?",{"text":121,"@type":113},"Two consecutive doses of obinutuzumab (300 mg/m2 BSA) were administered two weeks apart. Complete remission of severe nephrotic syndrome was achieved two months after the last infusion, with sustained resolution of proteinuria and normal serum albumin levels and no severe adverse effects reported.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461602,1790791565,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46},962090893057,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Case Report  \nSuccessful Therapy with Obinutuzumab in a Toddler with Primary Multidrug-Resistant Nephrotic Syndrome  \nMagdalena Drozynska-Duklas *, Ilona Zagozdzon , Ilona Chudzik , Irena Balasz-Chmielewska , Anna Kranz  and Aleksandra Zurowska   \nAcademic Editors: Giacomo Garibotto and Juan F. Navarro-González  \nReceived: 9 November 2025  \nRevised: 11 December 2025  \nAccepted: 18 December 2025  \nPublished: 22 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of Paediatrics, Nephrology and Hypertension, Medical University of Gdansk, 80-210 Gdansk, Poland;  \n[ilona.zagozdzon@gumed.edu.pl](ilona.zagozdzon@gumed.edu.pl) (I.Z.); [ilona.chudzik@gumed.edu.pl](ilona.chudzik@gumed.edu.pl) (I.C.); [ibalasz@gumed.edu.pl](ibalasz@gumed.edu.pl) (I.B.-C.);  \n[anna.kranz@gumed.edu.pl](anna.kranz@gumed.edu.pl) (A.K.); [aleksandra.zurowska@gumed.edu.pl](aleksandra.zurowska@gumed.edu.pl) (A.Z.)  \n* [Correspondence: mduklas@gumed.edu.pl](Correspondence: mduklas@gumed.edu.pl); Tel.: +48-583492850  \nAbstract  \nBackground/Objectives: Primary steroid-resistant nephrotic syndrome (SRNS) in children is an ominous diagnosis due to limited therapeutic options and poor prognosis. The younger the child, the greater the probability of a genetic etiology which is typically resistant to immunosuppressive therapy. International guidelines recommend genetic testing and a search for rare infectious causes in the youngest age group. When no identifiable etiology is found, an immunologic cause of SRNS is suspected, with few therapeutic options available, which lately have included anti-CD20 therapy for children > 7 years of age. This is the first report on the successful use of obinutuzumab in a very young child with primary SRNS. Methods: Two consecutive doses of obinutuzumab, a humanized anti-CD20 antibody (300 mg/m2 BSA), were administered two weeks apart to a 24-month-old boy with severe, complicated SRNS which had been refractory to cyclosporin A and rituximab and in whom previous genetic testing and a search for multiple infectious causes had been negative. Results: Complete remission of severe nephrotic syndrome was achieved 2 months after the last infusion with, to date, sustained resolution of proteinuria and normal serum albumin levels without further use of IMS drugs and no severe adverse effects noted. Conclusions: Obinutuzumab may be a rescue option for severe, multidrug-resistant ISN, even in young children, when no other therapeutic options are available.  \nKeywords: multidrug-resistant nephrotic syndrome; children; obinutuzumab  \n1. Introduction  \nPrimary steroid-resistant nephrotic syndrome (SRNS) is an ominous diagnosis ina child with nephrotic syndrome due to limited therapeutic options and high risk of a poor outcome. On recognition, a thorough search for infectious agents, including atypical etiologies, is mandatory, especially in very young children. IPNA and KDIGO recommendations underscore the importance of both early genetic testing and renal biopsy in order to differentiate between a genetic etiology unresponsive to immunosuppressive drugs (IMS) and an immunological disease which may respond to further intensified IMS therapy. If an immunologic background is probable, a course of calcineurin inhibitors (CNIs) and nephroprotective agents is recommended, though the response rate is highly variable 42–85%[1–4] . Treatment with plasmapheresis or immunoadsorption has been reported in single case reports or small series, with varied outcomes [5,6] . Lately, several reports have  \nbeen published on the efficacy of rituximab (RTX), an anti-CD20 antibody for SRNS; the presented results have been unequivocal but optimistic, with up to 40.8–58%[7,8] of children achieving remission with different dosing regimens. In SRNS subjects unresponsive to RTX, alternative B cell","cbCaieW99CQYBQPR","https://ap.wps.com/l/cbCaieW99CQYBQPR","pdf",206528,"English","# Abstract\n# 1. Introduction\n# 2. Case Presentation","[{\"question\":\"Why is primary steroid-resistant nephrotic syndrome (SRNS) concerning in young children?\",\"answer\":\"It is considered ominous because therapeutic options are limited and the prognosis can be poor. In very young patients, genetic etiologies are more probable and are often resistant to immunosuppressive therapy.\"},{\"question\":\"What diagnostic steps are recommended when SRNS is identified in very young children?\",\"answer\":\"Thorough evaluation for infectious agents, including atypical causes, is mandatory, and early genetic testing is emphasized. Guidance also supports renal biopsy to distinguish genetic disease from immunologic causes that may respond to intensified immunosuppression.\"},{\"question\":\"What treatment regimen and outcome were reported with obinutuzumab?\",\"answer\":\"Two consecutive doses of obinutuzumab (300 mg/m2 BSA) were administered two weeks apart. Complete remission of severe nephrotic syndrome was achieved two months after the last infusion, with sustained resolution of proteinuria and normal serum albumin levels and no severe adverse effects reported.\"}]","Successful Therapy with Obinutuzumab in a Toddler with Primary Multidrug-Resistant Nephrotic Syndrome - Case Report | PDF",1790761950]