Rituximab and RASi in Patients with IgAN

Inclusion Criteria:

1. 18 to 75 of age, male or female;

2. primary IgA nephropathy confirmed by renal biopsy

3. eGFR>30ml/min/1.73m2(calculated according to the CKD-EPI formula);

4. After using maximum tolerated doses of ACEI and/or ARB for 3 months, thefollowing two points should be met:

5. 24h proteinuria ≥1g;

6. Bp<130/80 mmHg；

5. Serum albumin > 25g/L;

6. Sign the informed consent.

Note : It is suggested that active IgAN patients should be selected. Active IgAN is specifically defined as conforming to any of the following :

1. ) intradermal augmentation ( E1 ),

2. ) crescentic body 0 - 50 % ( C1 / C2 ),

3. ) fibrinoid necrosis,

4. ) more interstitial inflammatory cell infiltration. At the same time, the proportionof sclerosis was low ( spherical or segmental sclerosis ball < 50 % ), andinterstitial fibrosis was low ( below T2 ).

Exclusion Criteria:

1. Evidence of the use of glucocorticoids for immunosuppressive therapy, such as:nephrotic syndrome, pathology for small lesions with IgA nephropathy. or theproportion of crescents confirmed by renal biopsy within 12 months was morethan 50 %.

2. Clinical confirmation of cirrhosis, chronic active liver disease, or hepatitisB, C, or HIV which can detect viral replication;

3. Clinically confirmed IgA nephropathy secondary to systemic diseases such assystemic lupus erythematosus, allergic purpura.

4. Patients with non-simple IgA nephropathy, such as diabetic nephropathy orobesity-related nephropathy.

5. A history of active systemic infection or severe infection occurred one monthbefore enrollment.

6. Those who are pregnant or lactating or unwilling to take contraceptivemeasures.

7. Current or recent ( within 30 days ) exposure to any research drug.

8. Patients with allergic reactions to rituximab and / or known allergicreactions.

9. Laboratory tests meeting the following criteria should be excluded:

(1) Hemoglobin <80g/L; (2) Platelet <80×10^9/L; (3) Neutrophils < 1.0×10^9/L; (4)Aspartic acid aminotransferase (AST) or alanine aminotransferase (ALT) >2.5× normalupper limit, except for the correlation with the primary disease;

10. Continuous use of hormones or other immunosuppressive therapy in the past 6months;

11. Accompanying or past malignant tumors, except for fully treated skin basal orsquamous cell carcinoma or cervical carcinoma in situ;

12. History of psychosis may interfere with normal participation in this study;

13. Patients with major heart or lung diseases (including obstructive pulmonarydisease);

14. In acute and chronic tuberculosis infection period (tuberculin test positive,chest X-ray suspected tuberculosis patients);

15. Patients with history of immunodeficiency, including other acquired orcongenital immunodeficiency diseases, or a history of organ transplantation;

16. Weight less than 50kg should be excluded;

17. Other researchers judge the patients unsuitable for inclusion in the study