title: Mycophenolate mofetil in high-risk patients with primary glomerulonephritis: results of a 1-year prospective study.
abstract: OBJECTIVE
  Glucocorticoids and classic immunosuppressive drugs can improve disease activity in primary glomerulonephritis (GN). However, these drugs have serious toxicity and patients frequently experience inadequate response or relapse, so there is a need for alternative agents. This multicenter uncontrolled study analyzed the efficacy and safety of mycophenolate mofetil (MMF) in high-risk patients with primary GN.
  
  
  METHODS
  A total of 51 patients with biopsy-proven membranous (n = 12), membranoproliferative (n = 15), mesangioproliferative (n = 10), focal segmental glomerulosclerosis (n = 13) and minimal change disease (n = 1) received MMF with low-dose corticosteroids for 1 year. The primary outcome included the number of patients with complete/partial remission.
  
  
  RESULTS
  Proteinuria significantly decreased, from its median value of 4.9 g/day (IQR 2.9-8.4) to 1.28 g/day (IQR 0.5-2.9), p < 0.001. The urine protein/creatinine ratio significantly improved, from a median of 3.72 (IQR 2.13-6.48) to 0.84 (IQR 0.42-2.01), p < 0.001. The mean area under the curve for proteinuria significantly decreased, from 4.99 +/- 3.46 to 2.16 +/- 2.46, between the first (visits 1-2) and last (vists 4-5) treatment periods (p < 0.001). The change was similar for every type of GN, without difference between groups. eGFR slightly increased (62.1 +/- 31.8 to 65.3 +/- 31.8 ml/min, p = n.s.) and ESR, total proteins, albumins, total- and HDL-cholesterol parameters improved significantly. Systolic, diastolic and mean blood pressure decreased (p < 0.02 for systolic blood pressure). The age of patients was the only independent predictor of complete or partial remission.
  
  
  CONCLUSIONS
  MMF proved to be efficient in 70% of high-risk patients with primary GN, who reached either complete or partial remission without safety concern after 12 months of treatment. Favorable effects of MMF therapy have to be confirmed in the long term and particularly after discontinuation of the drug.
authors.affiliation: Center for Renal Diseases, Zvezdara University Medical Center, Belgrade, Serbia. dim@eunet.yu
authors.forename: Nada
authors.initials: N
authors.lastname: Dimkovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Jovanovic
authors.forename: Zoran
authors.initials: Z
authors.lastname: Kovacevic
authors.forename: Violeta
authors.initials: V
authors.lastname: Rabrenovic
authors.forename: Vidosava
authors.initials: V
authors.lastname: Nesic
authors.forename: Marina
authors.initials: M
authors.lastname: Savin
authors.forename: Branka
authors.initials: B
authors.lastname: Mitic
authors.forename: Marina
authors.initials: M
authors.lastname: Ratkovic
authors.forename: Slobodan
authors.initials: S
authors.lastname: Curic
authors.forename: Igor
authors.initials: I
authors.lastname: Mitic
authors.forename: Steva
authors.initials: S
authors.lastname: Pljesa
authors.forename: Gordana
authors.initials: G
authors.lastname: Perunicic-Pekovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
authors.forename: Jovan
authors.initials: J
authors.lastname: Popovic
authors.forename: Danica
authors.initials: D
authors.lastname: Vujic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D009173:Mycophenolic Acid