Mycophenolate mofetil treatment for primary glomerular diseases.
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.
Choi
Michael J
MJ
Nephrology Division, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21205-2196, USA. mchoi3@jhmi.edu
Eustace
Joseph A
JA
Gimenez
Luis F
LF
Atta
Mohamed G
MG
Scheel
Paul J
PJ
Sothinathan
Renuka
R
Briggs
William A
WA
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
D013256:Steroids; D003404:Creatinine; D009173:Mycophenolic Acid