Background and Aims We hereby report three cases of biopsy proven Type 5 SLE membranous nephropathy (T5: SLEMN) which responded to Rituximab after failed first line induction agents.

Methods Retrospective chart review

Results Case 1: Rituximab was used in this 14 year old girl as she failed to standard therapy of cyclophosphamide (750 mg/m²) and high dose corticosteroid along with angiotensin convertase inhibitor (ACEI). 30 days post rituximab 24 hour proteinuria dropped (6790 to 876 mg) and albumin rose (1.8 mg/dl to 3 mg/dl). She is in remission at 14 month on low dose steroid and mycophenolate mofetil (MMF).

Case 2: 10 year old girl whose presentation was similar to Case 1 and failed to show any significant improvement tostandard therapy. 45 days post rituximab, 24 hour proteinuria dropped (4900 to 690 mg) and albumin rose (1.9 mg/dl to 3.3 mg/dl). At 12 month she is in remission on low dose steroid and MMF.

Case 3: 12 year old girl presented with features of nephrotic syndrome. At 30 days follow up there were no improvement despite standard therapy and she also started to have neuropsychiatric manifestation. 60 days post rituximab 24 hour proteinuria dropped (3548 to 300 mg) and albumin rose (1.8 mg/dl to 3.7 mg/d)l. Her neuro-psychiatric manifestation also improved.

Conclusions In all 3 cases 2 doses of rituximab at 375 mg/m² each achieved CD 19 count of zero (which normalised by 14, 9 and 11 month respectively) along with significant drop in proteinuria.