Mycophenolate mofetil treatment in primary glomerular disease: one-year follow-up in steroid dependent and resistant nephrotic syndrome.
OBJECTIVE
Treatment of primary nephrotic syndrome (NS) with steroid and cyclophosphamide may be unsuccessful and have much toxicity. Therefore, the authors evaluated the outcome of mycophenolate mofetil (MMF) treatment in these patients.


METHODS
Fourteen primary NS patients who had failure to steroid and/or cyclophosphamide therapy were treated by MMF for at least 3 months as alternative treatment. Median +/- SD (range) of urine protein to creatinine index (UPCI), serum albumin, serum creatinine, serum cholesterol and dose of prednisolone at the start, 1mo, 3 mo, 6mo, and 12 mo after MMF therapy were compared.


RESULTS
In the study group, the mean of UPCI decreased significantly from 2.79 +/- 8.1 to 1.81 +/- 1.54 (p = 0.02) at 12 months after the MMF therapy with no significant change in the mean serum creatinine from 1.14 +/- 0.45 to 1.27 +/- 0.67 mg/dL. The mean serum albumin increased significantly from 2.87 +/- 0.56 to 3.46 +/- 0.76 g/dL (p = 0.05) and the mean of prednisolone dosage decreased significantly from 34.64 +/- 19.16 to 11.11 +/- 8.58 mg/day (p = 0.004). For patients with IgM Nephropathy (IgMN), one of three steroid dependent patients presented with improved renal function. One of two patients with focal segmental glomerulosclerosis (FSGS) had a complete remission and one of two patients with IgA nephropathy (IgAN) had improved renal function with partial remission.


CONCLUSIONS
MMF therapy in NS patients with primary glomerular disease was well tolerated and safe. These efficacies can improve NS, stabilize renal function, and achieve steroid withdrawal.
Tasanarong
Adis
A
Nephrology Division, Faculty of Medicine, Thammasat University, Bangkok, Thailand.
Thitiarchakul
Supachai
S
D000328:Adult; D003520:Cyclophosphamide / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007678:Kidney Glomerulus; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000209:etiology*
D007166:Immunosuppressive Agents; D013256:Steroids; D003520:Cyclophosphamide; D009173:Mycophenolic Acid