Mycophenolate mofetil alleviates persistent proteinuria in IgA nephropathy.
BACKGROUND
Mycophenolate mofetil (MMF) is increasingly used to treat primary glomerulopathies. Its effectiveness in IgA nephropathy (IgAN) remains unclear.


METHODS
Forty IgAN patients with persistent proteinuria (>1 g/24 hours) despite conventional treatment with blockers of the renin-angiotensin system were randomized to receive MMF for 24 weeks (group 1) or continue conventional therapy (group 2), and followed for 72 weeks. The primary end point was reduction of proteinuria by 50% or more over entry level.


RESULTS
Sixteen patients (80%) in group 1 versus six patients (30%) in group 2 reached the primary end point (P= 0.0019). Time-averaged change in proteinuria showed a significant decline in group 1, while control subjects displayed a modest rise (P= 0.003). By 72 weeks, the mean proteinuria was 62.0 +/- 7.7% (P= 0.003) and 120.5 +/- 14.1% (P= 0.351) that of the corresponding baseline value in group 1 and group 2, respectively. There was concomitant increase in serum albumin and decrease in serum IgA levels in group 1 but not group 2 patients. Baseline histologic grades, blood pressure control, and the rates of change in serum creatinine and creatinine clearance were not different between the two groups. Normalization in binding of polymeric IgA to cultured mesangial cells and serum interleukin-6 (IL-6) levels, which sustained to study end, was observed in group 1 but not group 2 subjects.


CONCLUSIONS
In selected patients with IgAN, MMF is effective in lowering proteinuria and ameliorating some of the putative pathogenetic abnormalities.
Tang
Sydney
S
Nephrology Division, Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong Kong, China.
Leung
Joseph C K
JC
Chan
Loretta Y Y
LY
Lui
Yun Hoi
YH
Tang
Colin S O
CS
Kan
Chi Hang
CH
Ho
Yiu Wing
YW
Lai
Kar Neng
KN
D000328:Adult; D001794:Blood Pressure; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D012964:Sodium / Q000652:urine; D016896:Treatment Outcome
D007070:Immunoglobulin A; D007166:Immunosuppressive Agents; D012964:Sodium; D009173:Mycophenolic Acid