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Mycophenolate mofetil in steroid/cyclosporine-dependent/resistant nephrotic syndrome

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Abstract

Attempts to minimize the effects of prolonged steroid use in steroid-dependent nephrotic syndrome (SDNS) and the need to overcome steroid resistance (SRNS) justifies immunosuppressant therapy. We report our experience in a cohort of patients with SD/SRNS during the administration of mycophenolate mofetil (MMF) in a prospective protocol initiated in January 2001. Twenty-six children with idiopathic nephrotic syndrome were included (21 steroid dependent and 5 steroid resistant), whose response did not change after sequential treatment with cyclophosphamide (CPM) and cyclosporine (CsA). Histopathologic patterns were: 11 minimal change disease (MCD), 1 diffuse mesangial proliferation (DMP), 13 focal segmental glomerulosclerosis (FSGS) and membranous 1 glomerulonephritis (MGN). The median age of onset of NS was 2.8 years (range 1.2–12.5), and treatment with MMF was performed at a median age of 11.4 years (range 5–17) with an initial dose of 600 mg/m2/12 h, adjusted to maintain levels of mycophenolic acid (MPA) at 2.5–5 mcg/ml. The planned duration of study to assess treatment efficacy was 6 months. The mean MMF dose required was 624 (SD=136) mg/m2/12 h (range 415–970), which maintained mean C0-MPA levels of 2.9 (SD=1.17) mcg/ml (range 1.2–5.9 mcg/ml). In the five patients with SRNS, only one achieved complete remission. In the patients with SDNS, steroid sparing was achieved in 15 and 9 remained in remission on MMF monotherapy. Withdrawal of MMF resulted in immediate relapse in 47%. In our study, MMF was a useful immunosuppressant due to its fewer undesirable effects and similar efficacy to other drugs used. It appears effective for the maintenance of remission in SDNS patients, with a response similar to that of CsA.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, La Fe Hospital, Avda. Campanar 21, 46009, Valencia, Spain

    S. Mendizábal, I. Zamora, O. Berbel, M. J. Sanahuja, J. Fuentes & J. Simon

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  1. S. Mendizábal
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  2. I. Zamora
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  3. O. Berbel
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  4. M. J. Sanahuja
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  5. J. Fuentes
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Correspondence to S. Mendizábal.

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Mendizábal, S., Zamora, I., Berbel, O. et al. Mycophenolate mofetil in steroid/cyclosporine-dependent/resistant nephrotic syndrome. Pediatr Nephrol 20, 914–919 (2005). https://doi.org/10.1007/s00467-005-1877-x

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  • DOI: https://doi.org/10.1007/s00467-005-1877-x

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