Use of mizoribine as a rescue drug for steroid-resistant pediatric IgA nephropathy.
Recent clinical trials have shown a beneficial effect of mizoribine (Miz), an immunosuppressive drug, in the treatment of new-onset pediatric IgA nephropathy (IgAN). In this study, we evaluated the efficacy of Miz treatment in three children with established steroid-resistant IgAN. The patients had IgAN featuring persistent proteinuria and diffuse mesangial proliferation and had failed to respond to 2 years of treatment with prednisolone. Based upon the second biopsy results, patients were given methylprednisolone (mPSL) pulse therapy that induced a transient reduction in proteinuria, which was reversed when the mPSL dose was tapered. Miz therapy was then instigated in place of pulse mPSL. All three patients showed a substantial reduction in proteinuria and resolution of hematuria within 5 months. A follow-up biopsy in two of the patients showed a substantial reduction in the severity of glomerular lesions and a decrease in the number of activated macrophages. In conclusion, Miz therapy was found to be a safe and effective therapy in three cases of steroid-resistant pediatric IgAN. The ability of Miz to reduce the number of activated macrophages may be an important mechanism by which this drug ameliorated renal disease in these patients.
Department of Pediatrics, Niigata University Medical and Dental Hospital, Asahimachi-Dori, Niigata, Japan. ikezumi@med.niigata-u.ac.jp
Yohei
Y
Ikezumi
Toshiaki
T
Suzuki
Tamaki
T
Karasawa
Hiroshi
H
Kawachi
David J
DJ
Nikolic-Paterson
Makoto
M
Uchiyama
D000293:Adolescent; D002648:Child; D004351:Drug Resistance / Q000187:drug effects*; D005260:Female; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000473:pathology; D006417:Hematuria / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology; D008262:Macrophage Activation / Q000187:drug effects; D008775:Methylprednisolone / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use*; D011507:Proteinuria / Q000188:drug therapy; D012263:Ribonucleosides / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D011239:Prednisolone; D008775:Methylprednisolone