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Switch from cyclosporine A to mycophenolate mofetil in nephrotic children

Tim Ulinski1, Laurence Dubourg, Marie Hélène Saïd

  • 1Department of Pediatrics, Nephrology Unit, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.

Pediatric Nephrology (Berlin, Germany)
|February 19, 2005
PubMed

Insights

Switching children with nephrotic syndrome from cyclosporine A (CyA) to mycophenolate mofetil (MMF) improved kidney function and allowed for steroid reduction. MMF proved safe and effective in managing both steroid-dependent and steroid-resistant nephrotic syndrome in this cohort.

Area of Science:

  • Pediatric Nephrology
  • Pharmacology
  • Immunosuppression

Background:

  • Cyclosporine A (CyA) treatment for nephrotic syndrome (NS) in children can cause nephrotoxicity, leading to decreased glomerular filtration rate (GFR).
  • Steroid-dependent (SD) and steroid-resistant (SR) NS require effective immunosuppressive therapy, but long-term side effects are a concern.

Purpose of the Study:

  • To evaluate the safety and efficacy of switching from CyA to mycophenolate mofetil (MMF) in pediatric patients with SD or SR NS experiencing CyA-induced nephrotoxicity.
  • To assess the impact of this switch on renal function, proteinuria, and steroid requirements.

Main Methods:

  • Nine children with SD or SR NS and reduced GFR under CyA were switched to MMF (1 g/1.73 m(2) twice daily).
  • CyA was withdrawn, and oral steroid doses were reduced if possible.
  • Patients were monitored for adverse effects, proteinuria, serum protein levels, GFR, and blood pressure.

Main Results:

  • No significant adverse effects (diarrhea, hematological anomalies) were observed with MMF.
  • GFR significantly increased post-switch (mean 76.9 to 119.9 mL/1.73 m(2)/min; P<0.001).
  • Oral steroid doses were significantly reduced (median 0.85 to 0.29 mg/kg/d; P=0.026), with stable remission in SD NS and no significant change in proteinuria in SR NS.

Conclusions:

  • Switching from CyA to MMF is a safe short-term option for children with SD/SR NS, improving kidney function and enabling steroid-sparing.
  • Interruption of CyA led to rapid GFR amelioration, potentially benefiting growth, blood pressure, and physical appearance.

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