{
  "abstract": "Background: Rituximab is widely used for difficult steroid-dependent and frequently relapsing nephrotic syndrome (SDNS/FRNS). Persistent hypogammaglobulinaemia (PH) after rituximab is increasingly recognised, but data from low- and middle-income settings remain limited.\n\nMethods: In this multicentre cross-sectional study, children <18 years with SDNS/FRNS who had received rituximab ≥12 months earlier were evaluated for serum immunoglobulin G (IgG) levels. PH was defined as IgG<2 SD below age-adjusted norms ≥12 months after the last rituximab dose. Logistic regression was performed to identify predictors of PH. Infection-related hospitalisation rates were compared between groups.\n\nResults: Among 109 children (median age 10.2 years; median 24 months since last rituximab), 27 (25%) had PH. Younger age at first rituximab independently predicted PH (OR 0.968 per year (95% CI 0.947 to 0.990); p=0.005). PH prevalence declined progressively with increasing age at first exposure (71% in 2–3.9 years vs 12% in ≥8 years; p=0.005). Overall, 12% required hospitalisation for severe infections; infection-related hospitalisation rates were higher among children with hypogammaglobulinaemia (0.41 vs 0.07 per year; p=0.002).\n\nConclusion: In this cross-sectional cohort, hypogammaglobulinaemia was detected in one-quarter of children ≥12 months after rituximab exposure and was independently associated with younger age at first exposure. Hypogammaglobulinaemia was also associated with higher infection-related hospitalisation rates, although this exploratory association cannot establish causality. Prospective longitudinal studies are needed to define IgG recovery and infection risk after rituximab.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pediatrics, Institute of Child Health, Kolkata, India",
    "Department of Pediatrics, All India Institute of Medical Sciences, Kalyani, West Bengal, India",
    "Department of Paediatric Nephrology, Great North Children’s Hospital, Newcastle Upon Tyne, UK"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Suchismita Saha"
    },
    {
      "affs": [
        0
      ],
      "name": "Deepshikha Baranwal"
    },
    {
      "affs": [
        1
      ],
      "name": "Subhankar Sarkar",
      "orcid": "0000-0002-4425-7102"
    },
    {
      "affs": [
        0
      ],
      "name": "Sanjukta Poddar"
    },
    {
      "affs": [
        0
      ],
      "name": "Shakil Akhtar"
    },
    {
      "affs": [
        2
      ],
      "name": "Yincent Tse",
      "orcid": "0000-0003-3175-1475"
    },
    {
      "affs": [
        0
      ],
      "name": "Rajiv Sinha",
      "orcid": "0000-0003-4525-092X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7q9mv5ekm82sh.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjpo-2026-005067",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13735300/",
  "id": "7q9mv5ekm82sh",
  "issns": [
    "2399-9772"
  ],
  "landing_url": "https://doi.org/10.1136/bmjpo-2026-005067",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Nephrology"
    ],
    [
      "openalex",
      "2727|Renal Diseases and Glomerulopathies"
    ]
  ],
  "openalex": "W7225183275",
  "pdf_url": "https://bmjpaedsopen.bmj.com/content/10/1/e005067.full.pdf",
  "pmcid": "PMC13735300",
  "pmid": "42971803",
  "published": "2026-11-02",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/7q9mv5ekm82sh.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:00Z",
      "native_id": "PMC13735300",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjpo-2026-005067"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Renal Diseases and Glomerulopathies",
      "subfield": "general"
    }
  ],
  "title": "Persistent hypogammaglobulinaemia after rituximab in children with difficult-to-treat nephrotic syndrome: a multicentre cross-sectional observational study",
  "title_text": "Persistent hypogammaglobulinaemia after rituximab in children with difficult-to-treat nephrotic syndrome: a multicentre cross-sectional observational study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:00Z",
  "url": "https://research.draconitic.com/paper/7q9mv5ekm82sh",
  "venue": "BMJ Paediatrics Open",
  "versions": []
}