Rituximab in Progressive Immunoglobulin A (IgA) Nephropathy

Inclusion Criteria: * Any patient between the age of 18 and 70 years of age and able to give informed consent * GFR by Cockcroft-Gault or MDRD equations \<90 mls/min and \>30 mls/min * Greater than or equal to 1000 mg of proteinuria/24 hours while on stable ACEi, ARB or renin inhibitor therapy for 2 months. Patients receiving combination ACE or ARB or ACEi and a renin inhibitor for 2 months will only require 500mg/24 hours * Blood pressure \<130/80 mmHg. The presence of hypertension is not required for study entry, but any patient requiring long term hypertensive medications must have blood pressure controlled \<130-80 mmHg, to be considered eligible for the study * Female patients with IgA will be considered eligible for study entry if they have a negative urine or serum pregnancy test at the time of screening are agreeable to 2 years of contraception * Biopsy proven IgA nephropathy and clinical features consistent with Henoch Schonlein Purpura will be considered eligible for the study * Able to swallow the oral medications Exclusion Criteria * Clinical and histologic evidence of IgA predominant Lupus nephritis * Clinical and histologic evidence of idiopathic IgA forms of membranoproliferative glomerulonephritis * Clinical evidence of cirrhosis, chronic active liver disease or known infection with hepatitis B, C or HIV * Estimated GFR \<30 ml/min/1.73m² at the time of screening * Greater than 50% glomerular senescence or cortical scarring on renal biopsy * Active systemic infection or history of serious infection within one month of entry * History of Crohn's disease or Celiac Sprue * Positive pregnancy test or breast feeding at time of study entry or unwilling to comply with contraceptive measures * Current or recent (within 30 days) exposure to any investigational drug * Serum Cr \>3.5 mg/dl or Modification of Diet in Renal Disease (MDRD) calculated GFR \<30 mls/min * Patients receiving \>6 months therapy with oral prednisone or glucocorticoid equivalent * Live vaccine within 28 days of study enrollment. General Safety \& Laboratory Exclusion Criteria * Patients with anaphylaxis and/or known allergic reactions to Rituximab * Hemoglobin: \<8.5 gm/dL * Platelets: \<100,000/mm * Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \>2.5 x Upper Limit of Normal unless related to primary disease. * Previous Treatment with Rituximab(MabThera®/Rituxan®) * Previous treatment with Natalizumab(Tysabri®) * History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies * History of recurrent significant infection or recurrent bacterial infections * Known active bacterial, viral fungal mycobacterial or atypical mycobacterial infections, but excluding fungal infections of nail beds * Any major episode of infection requiring hospitalization or treatment with i.v. antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks prior to screening * Ongoing use of high dose steroids(\>10 mg/day)or unstable steroid dose in the past 4 weeks * Lack of peripheral venous access * History of drug, alcohol, or chemical abuse within 6 months prior to screening * Pregnancy (a negative serum or urine pregnancy test will be performed for all women of childbearing potential no later than 7 days prior to treatment) or lactation * Concomitant or previous malignancies, with the exception of adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix * History of psychiatric disorder that would interfere with normal participation in this protocol * Significant cardiac or pulmonary disease (including obstructive pulmonary disease) * Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complication * Inability to comply with study and follow-up procedures