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Severe pneumonia in mycophenolate mofetil combined with low-dose corticosteroids-treated patients with immunoglobulin

Qi-Jun Wan1, Hao-Fei Hu1, Yong-Cheng He1

  • 1Department of Nephrology, Shenzhen Second People's Hospital, Guangdong, China.

The Kaohsiung Journal of Medical Sciences
|January 21, 2015
PubMed

Insights

Mycophenolate mofetil (MMF) combined with low-dose corticosteroids can cause severe pneumonia (SP) in advanced IgA nephropathy (IgAN). Chronically impaired renal function and methylprednisolone use are identified as risk factors for SP in these patients.

Area of Science:

  • Nephrology
  • Pulmonology
  • Pharmacology

Background:

  • Immunoglobulin A nephropathy (IgAN) is a common glomerular disease.
  • Treatment for advanced IgAN (Lee Classes III-V) often involves immunosuppressants like mycophenolate mofetil (MMF) and corticosteroids.
  • The safety profile of MMF in combination with low-dose corticosteroids for advanced IgAN is not fully established.

Purpose of the Study:

  • To investigate the incidence and risk factors of severe pneumonia (SP) in patients with advanced IgAN treated with MMF and low-dose corticosteroids.
  • To identify specific patient characteristics or treatment regimens associated with increased SP risk.

Main Methods:

  • A single-center study included 53 patients with IgAN (Lee Classes III-V).
  • Patients received MMF (1-1.5 g/d) plus low-dose corticosteroids (0.5 mg/kg/d).
  • Severe pneumonia was defined as diffuse bilateral lung infiltrate with respiratory failure; Pneumocystis pneumonia (PCP) and Cytomegalovirus (CMV) pneumonia were diagnosed using specific microbiological and serological tests.

Main Results:

  • Nine cases (16.9%) of SP occurred, primarily between the 10th-14th week of treatment.
  • PCP was diagnosed in four patients and CMV pneumonia in two.
  • Patients with SP showed more severe renal function impairment (lower eGFR, higher serum creatinine) compared to those without SP.
  • A statistically significant higher incidence of SP was observed in the MMF plus methylprednisolone group compared to the MMF plus prednisone group (p = 0.000).

Conclusions:

  • The combination of MMF and low-dose corticosteroids is associated with a significant risk of severe pneumonia in advanced IgAN.
  • Chronically impaired renal function and the use of methylprednisolone appear to be risk factors for developing SP in this patient population.
  • Further research is warranted to optimize immunosuppressive strategies and mitigate pulmonary risks in IgAN management.
Keywords:
CytomegalovirusIgA nephropathyMycophenolate mofetilPneumocystis pneumoniaSevere pneumonia

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