title: Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome.
abstract: The purpose of this study was to assess the results of therapy with mycophenolate mofetil (MMF) in children with idiopathic nephrotic syndrome (INS) who were both steroid- and cyclophosphamide-resistant. Treatment lasted a minimum of 6 months, and follow-up data were collected over a 2-year period. The children were divided into two groups: Group 1 (n=34) comprised patients who had received cyclosporine A (CsA) before the initiation of MMF therapy; Group 2 (n=18) comprised patients who received only MMF. Among the 34 patients of Group 1, complete and partial remission were achieved in seven (20.6%) and 13 patients (38.6%), respectively; there was no response in 14 patients (41.2%). Among the 18 patients in Group 2, complete and partial remission occurred in five (27.8%) and six (33.3%) patients, respectively; there was no response in seven patients (38.9%). Eight patients developed chronic kidney disease. The main side-effects were gastrointestinal complaints (n=11, 21%), recurring severe infections (n=1, 1.9%), and mild thrombocytopenia/leucopenia (n=1, 1.9%). MMF proved to be therapeutically effective in 59.5% of the cases. These beneficial effects need to be confirmed in studies with a long-term follow-up after discontinuation of the treatment. Our statistical analysis of the results of therapy with MMF did not reveal any significant difference between its use alone or following CsA administration.
authors: Department of Pediatrics, Division of Pediatric Nephrology, Santa Casa de São Paulo, Rua Cesario Motta Jr, 112 ZC 01221-020 São Paulo, Brazil.
authors: Valderez Raposo
authors: VR
authors: de Mello
authors: Maira Tinte
authors: MT
authors: Rodrigues
authors: Tais Helena
authors: TH
authors: Mastrocinque
authors: Simone Paiva Laranjo
authors: SP
authors: Martins
authors: Olberes Vitor Braga
authors: OV
authors: de Andrade
authors: Eliana Biondi Medeiros
authors: EB
authors: Guidoni
authors: Daniel Kashiwamura
authors: DK
authors: Scheffer
authors: Dino
authors: D
authors: Martini Filho
authors: Julio
authors: J
authors: Toporovski
authors: Vanda
authors: V
authors: Benini
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D004351:Drug Resistance; D005006:Ethnicity; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000473:pathology; D012727:Sex Characteristics; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D003520:Cyclophosphamide; D009173:Mycophenolic Acid