This leaflet has been written to inform you about a medication called rituximab. Your child’s kidney doctor has recommended rituximab as a treatment for your child’s kidney condition.
What is the immune system?
The role of the immune system is to protect you from infections. These can include viral, bacterial and fungal illnesses.
The immune system does this by making special white blood cells known as lymphocytes. One form of lymphocyte is called a “B-cell” which produces a protein called an antibody. Antibodies help the immune system to recognise bacteria and viruses and destroy them.
There are certain diseases which cause the immune system to attack the healthy cells in your body. This is known as an auto-immune disease. Some kidney conditions like nephrotic syndrome and systemic lupus erythematous (SLE) are thought to be auto-immune diseases and your kidney doctor may decide that this needs treatment with rituximab. Rituximab is also sometimes used by kidney doctors to treat rejection in transplant kidneys.
What is rituximab?
Rituximab is a medication which reduces and destroys the number of B-cells in your body. Your child’s kidney doctor will explain why rituximab is an appropriate treatment and discuss the beneï¬ts for your child’s kidney disease.
It can take 4-6 weeks to take effect, and your child will be monitored during this time.
How will my child be given the rituximab?
Rituximab is a clear medicine that is given through a vein using a drip (cannula). This medicine has to be given at Leeds Children’s hospital. Your child will usually receive two doses of rituximab 2 weeks apart but the exact regime can vary depending on the underlying condition that is being treated. Your kidney doctor will provide more detail about what treatment with rituximab will involve. Your kidney doctor will talk to you about further treatments if required
What will happen before the infusion?
Your child will need to have a series of blood tests before the rituximab infusion. This will be to check your child’s kidney function, full blood count, liver function as well as some common viruses.
Your doctor will ask you about any medications that your child takes and may tell you not to take a particular medication on the day of your treatment.
If your child has been feeling unwell, had a temperature, diarrhea or vomiting prior to the infusion being due then please let us know as they need to be well prior to the infusion
What to expect on the day of treatment
You will need to arrive at Leeds Children’s Hospital on the morning of your child’s infusion. They can have their usual breakfast that morning unless your kidney doctor has told you otherwise.
When you arrive, the doctor will explain the risks and beneï¬ts and seek verbal consent. Your child will then be reviewed by the doctor to check it is safe to administer the medication.
A cannula will then be inserted.
60 minutes before starting the rituximab infusion, your child will be given two medicines by mouth:
- Chlorphenamine (an antihistamine known as Piriton)
- Paracetamol
These are to help reduce reactions to the infusion.
An hour after these medicines have been administered, your child will be given the rituximab infusion. This can take between 6-8 hours depending on your child’s weight.
Your child will be monitored at various points and have observations checked, including; heart rate, breathing rate, blood pressure and temperature.
What side effects could my child experience?
Like with all medicines, this medicine can cause side effects, although not everybody gets them. Most side effects are mild to moderate but some may be serious and require treatment.
Infusion reactions
Mild symptoms may be seen whilst your child is having the rituximab infusion. This is more likely to happen with the first infusion which is why the infusion is given slowly and why you are given the antihistamine and paracetamol before. These are much less likely with your second infusion if you didn’t experience any with your first infusion.
Let your nurse know if you experience any of the below during your infusion:
- Skin rashes, itching, fever, shivering, dizziness, headache, chills, abdominal pain, diarrhea
In the event of a infusion reaction, the medication will be slowed down, given over a longer period of time or stopped.
Infections
- Rituximab affects how your immune system fights infection, so after the infusion for child will be more prone to infection.
- Progressive multifocal leukoencephalopathy: Infection of the brain by a virus which can cause personality changes, diffculty speaking/ walking and facial drooping. This is very rare and occurs in less than 2 in every 100, 000 patients treated with rituximab.
Skin
- Itchy rashes and blistering can be seen some time after a rituximab infusion. Please inform your kidney doctor if these occur.
Other
- Arrhythmias: chest pain, rapid heartbeat or pounding sensation in the chest
What else do I need to know?
Your child will have an increased risk of developing an infection. Try to avoid people with infections like colds, flu or chicken pox.
If you require care from any of the following; dentists, surgeons, pharmacists and other doctors, then tell them that your child has previously been treated with rituximab.
Some immunisations cannot be given within 6 months of after having a rituximab infusion, please discuss any immunisations that are required with your GP/Kidney doctor
Let your doctor know if your child develops a rash within 4 months of receiving rituximab.
Follow up bloods will be required to ensure the B cells are reducing accordingly. These will be arranged for when your child attends clinic.
Useful information and resources
