Klomjit N, et al. - Researchers define 3 cases of M-type phospholipase A₂ receptor (PLA₂R)-related membranous nephropathy (MN) that were successfully managed with obinutuzumab, and in these patients rituximab failed to induce immunologic or clinical remisison. The first case was: a 54-year-old white woman having PLA₂R-related MN diagnosed on the basis of kidney biopsy following presentation with nephrotic syndrome. Management of this case involved administering 2 doses of rituximab (1 g each) intravenously (IV) 2 weeks apart. The second case involved a 61-year-old white man with PLA₂R-associated MN and the third case involved a 54-year-old white man with the same disease. All 3 patients showed PLA₂R antibody positivity with average urinary protein excretion > 15 g/d prior to the start of any treatment. After rituximab therapy, all patients were identified to exhibit PLA₂R antibody titers > 2 RU/mL despite an initial decrease in titers. In these cases, the observed robust depletion of B cells with obinutuzumab was consistent with what is known to date regarding obinutuzumab. Overall, treatment with obinutuzumab afforded complete immunologic remission in all 3 patients and was followed by partial remission in 2 of the cases. Based on the findings, experts inferred that obinutuzumab holds promise as a therapeutic option for PLA₂R-associated MN that fails to respond to rituximab.