title: Mycophenolate mofetil treatment for primary glomerular diseases.
abstract: BACKGROUND
  Treatment of primary glomerular diseases may be unsuccessful or have potential toxicities. Therefore, we evaluated the use of mycophenolate mofetil (MMF) for empirical treatment of primary glomerulopathies.
  
  
  METHODS
  Forty-six patients with biopsy-proven primary glomerulopathies received MMF for > or =3 months as adjunctive or primary treatment. Median (range) 24-hour urine protein to creatinine ratio (Up/c) and serum creatinine at the start and end of MMF therapy were compared using the Wilcoxon signed-ranks test.
  
  
  RESULTS
  Overall, the median Up/c decreased from 4.7 (range <0.1, 20.3) to 1.1 (<0.1, 14.3; P < 0.001) at the end of MMF treatment with no significant change in median serum creatinine 1.3 (0.6 to 6.1) to 1.2 (0.5 to 6.5) mg/dL. Median serum albumin increased from 3.4 (1.4, 4.6) to 4.1 (1.7, 48) g/dL (P < 0.001) and the median serum cholesterol decreased from 270 (148, 795) to 220 (140, 309) mg/dL (P < 0.001) post-treatment. For those with minimal change disease, a complete steroid withdrawal was accomplished in 5/6 steroid dependent patients. Focal segmental glomerulosclerosis (FSGS) patients had a median Up/c that decreased from 2.7 (0.1, 20.3) to 0.8 (<0.1, 8.2; P = 0.001) in 18 patients. In membranous nephropathy (MN) patients, the median Up/c decreased from 7.3 (0.1, 18.5) to 1.5 (<0.1, 14.3) (P = 0.001) in 17 patients. No significant change in median serum creatinine was detected in FSGS or MN patient groups during treatment.
  
  
  CONCLUSIONS
  Empirical MMF therapy in the majority of patients with primary glomerulopathies was well tolerated and achieved the goals of steroid withdrawal, improvement of nephrotic syndrome, and stabilization of renal function.
authors.affiliation: Nephrology Division, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21205-2196, USA. mchoi3@jhmi.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Choi
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Eustace
authors.forename: Luis F
authors.initials: LF
authors.lastname: Gimenez
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Scheel
authors.forename: Renuka
authors.initials: R
authors.lastname: Sothinathan
authors.forename: William A
authors.initials: WA
authors.lastname: Briggs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D007678:Kidney Glomerulus; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D009402:Nephrosis, Lipoid / Q000188:drug therapy; D011507:Proteinuria / Q000652:urine; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D013256:Steroids; D003404:Creatinine; D009173:Mycophenolic Acid