Randomized Trial Comparing Rituximab Against Mycophenolate Mofetil in Children Wtih Refractory Nephrotic Syndrome

Inclusion Criteria: * SDNS or FRNS * Complete remission, defined by absence of edema and 3 consecutive daily urine dipstick readings of trace or negative for protein * Must be taking MMF and have had at least one relapse while taking MMF in the prior 6 months that responded to corticosteroid treatment by re-entering complete remission at least 2 weeks prior to study entry. * BMI prior to onset of NS \<99th percentile * Age 1-18 years * Estimated GFR \>40 ml/min/1.73m² (by Modified Schwartz formula) * Negative serum pregnancy test (for females who are tanner stage 4 or 5) * Males and females of reproductive potential (sexually active in boys or post-menarche in girls) must agree to use an acceptable method of birth control during treatment and for twelve months (1 year) after completion of treatment Exclusion Criteria: * • Prior therapy with rituximab, tacrolimus or cyclosporine * Prior therapy with cytotoxic agents in the past 90 days * History of genetic defects known to directly cause nephrotic syndrome (i.e. NPHS2 (podocin), NPHS1 (nephrin), PLCE1, WT1) * History of or concomitant severe, active infection (e.g. HIV, hepatitis B, hepatitis C) * History of diabetes mellitus * History of organ or bone marrow transplant * Secondary nephrotic syndrome (i.e. reflux nephropathy, IgA nephropathy, lupus nephritis, etc) * Live viral vaccines administered in the past 6 weeks (42 days) * Participation in another therapeutic trial within 30 days of enrollment * Al…