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Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome

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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.

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Acknowledgements

We would like to express our gratitude to EMS-Sigma Pharma for supplying us with the MMF for this study.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, Santa Casa de São Paulo, Rua Harmonia 756 ap 122, 05435-000, SP, São Paulo, Brazil

    Vanda Benini

  2. Department of Social Medicine, Santa Casa de São Paulo, Rua Cesario Motta Jr, 112 ZC 01221-020, São Paulo, Brazil

    Daniel Kashiwamura Scheffer

  3. Department of Pathology, Santa Casa de São Paulo, Rua Cesario Motta Jr, 112 ZC 01221-020, São Paulo, Brazil

    Dino Martini Filho

  4. Department of Pediatrics, Division of Pediatric Nephrology, Santa Casa de São Paulo, Rua Cesario Motta Jr, 112 ZC 01221-020, São Paulo, Brazil

    Valderez Raposo de Mello, Maira Tinte Rodrigues, Tais Helena Mastrocinque, Simone Paiva Laranjo Martins, Olberes Vitor Braga de Andrade, Eliana Biondi Medeiros Guidoni & Julio Toporovski

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  1. Valderez Raposo de Mello
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  2. Maira Tinte Rodrigues
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Correspondence to Vanda Benini.

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de Mello, V.R., Rodrigues, M.T., Mastrocinque, T.H. et al. Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome. Pediatr Nephrol 25, 453–460 (2010). https://doi.org/10.1007/s00467-009-1356-x

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  • DOI: https://doi.org/10.1007/s00467-009-1356-x

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