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[Mycophenolate mofetil in the treatment of primary nephrotic syndrome]
1Institute of Nephrology, The First Hospital of Peking University, Beijing 100034, China.
Objective:
To investigate the efficacy and safety of mycophenolate mofetil (MMF) on treating refractory primary nephrotic syndrome.
Methods:
Forty-one patients with refractory nephrotic syndrome confirmed by renal biopsy, 19 with minor lesion (minimal lesion nephropathy and mesangial proliferative glomerulonephritis), 18 with membranous nephropathy (MN), 3 with focal segmental glomerulosclerosis (FSGS), and one with mesangioproliferative glomerulonephritis (MPGN), were treated by MMF combined with prednisone. The initial dosage of MMF was 1.0 - 2.0 g/d for three months and then the dosage was tapered gradually. The duration of MMF treatment was at least six months. Prednisone at the dose of 20 - 60 g/d was used at the beginning of the combined treatment and then the dosage was tapered gradually. Follow-up interview was conducted regularly. Four patients were rebiopsyed by the end of observation.
Results:
The combined treatment of MMF/prednisone decreased the urine protein and elevated the serum albumin significantly among patients with minor lesion and MN (P < 0.001). All patients with minor lesion achieved clinical remission. Eleven of the nineteen cases responded within four weeks, and twelve of them obtained complete clinical remission. The dosage of prednisone could be tapered smoothly among the steroid dependent patients. Thirteen of the eighteen patients with MN achieved remission, however only six responded within four weeks and only three of them achieved complete clinical remission. During the treatment, four patients experienced transient increase of urine protein due to infection and recovered spontaneously without alteration of treatment. Side effects were tolerable except one case was withdrawn due to the decrease of hemoglobin. Renal function remained stable during the treatment. No obvious alteration could be found in renal biopsy by the end of treatment among four patients.
Conclusion:
MMF is an effective and safe immunosuppressive agent for refractory nephrotic syndrome.