title: High-dose mycophenolate mofetil in the treatment of posttransplant glomerular disease in the allograft: a case series.
abstract: BACKGROUND
  Glomerular disease is an important cause of allograft loss. Treatment regimens for posttransplant glomerular disease are not well defined. Several reports have demonstrated that mycophenolate mofetil (MMF) is effective in treating native kidney glomerular disease. The effects of MMF are dose related. Therefore, we hypothesized that high-dose MMF (3 g/day) would be effective in treating glomerular disease in the allograft, minimizing the need for intravenous steroids and/or cyclophosphamide. This case series describes the results of the use of high-dose MMF in 6 patients.
  
  
  METHODS
  High-dose MMF (3 g/day) was used to treat biopsy-proven glomerular disease (focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, proliferative lupus nephritis, and perinuclear antineutrophil cytoplasmic antibodies glomerulonephritis) in 6 renal transplant recipients. Patients were offered this treatment if they had failed or did not tolerate standard treatment regimens. Remission was defined by a decrease or stabilization of serum creatinine, decrease in proteinuria and, where applicable, improvement in immunological markers of disease.
  
  
  RESULTS
  All 6 patients had disease remission after starting MMF with the most common side effect being leukopenia, which responded to dose reduction.
  
  
  CONCLUSIONS
  High-dose MMF may be an effective agent in treating glomerular disease in the allograft.
authors.affiliation: Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md, USA. jeanwu@jhmi.edu
authors.forename: Jean
authors.initials: J
authors.lastname: Wu
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: William A
authors.initials: WA
authors.lastname: Briggs
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Choi
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kraus
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Racusen
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
authors.forename: Milagros D
authors.initials: MD
authors.lastname: Samaniego
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005921:Glomerulonephritis; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000209:etiology; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012074:Remission Induction
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid