Mycophenolate mofetil for treatment of idiopathic nephrotic syndrome – a single center experience (preliminary study)

• Authors: D. Tomczyk , A. Jander , J. Mihailescu , M. Tkaczyk
• Languages of publication: EN

Abstracts

Introduction: Mycophenolate mofetil (MMF) is used in treatment of idiopathic nephrotic syndrome in children (INS). Purpose: To evaluate clinical results of MMF treatment in steroid-dependent (SD) and steroid-resistant (SR) nephrotic syndrome. Materials and methods: A retrospective analysis of 26 patients (19 boys, 7 girls) with SDINS and SRINS treated with MMF during the years 2003–2013 was made. The remission length of INS and number of relapses per year before the introduction of MMF and after 12 months was calculated. An analysis of the side effects was made. Results: The median age of INS diagnosis was 26.5 months (IQRs 24-36 months). Nineteen of the patients (73%) suffered from SDINS whereas the remaining 7 (27%) had SRINS. Twenty three (88.5%) patients underwent renal biopsy: minimal change disease (MCD) in 69.6% (n=16), focal segmental glomerulosclerosis (FSGS) in 17.4% (n=4), membranoproliferative glomerulonephritis (MPGN) in 8.7% (n=2) and mesangial cell proliferation in one case. The median MMF dosage was 956.0 mg/m2/24h (IQRs 768.1-1059.7 mg/m2/24h). Eleven patients (42.3%) were taking MMF together with cyclosporine A (CsA). In patients suffering from SDINS, there was a trend to lower the recurrence rate during MMF treatment [2.0/year (IQRs 0.25-2.0 per year) vs 2.0/year (IQRs 1.0-2.75 per year), p=0.09]. Remission without proteinuria was significantly longer in patients treated with MMF; remission median was 8.5 month (IQRs 6.25-11.0 month) vs 4.5 month (IQRs 4.0-7.5 month), (p=0.014), similarly the average length of remission without corticosteroids was 6.0 months (IQRs 0.25-8.5 months) vs 3.0 months (IQRs 0.0-7.25) months (p=0.028). In children SRINS, 4/7 children MMF treatment was clinically ineffective. Side effects of the treatment were: leucopenia (n =10), hyperbilirubinemia (n = 3), gastrointestinal disorders (n = 1) and anemia (n = 1). Conclusion: This study confirmed the efficacy of the treatment with MMF in SDINR in comparison with previously used drugs, with a small number of side effects.

Keywords

EN

idiopathic nephrotic syndrome; mycophenolate mofetil; child; recurrence

• Publisher: Uniwersytet Medyczny w Białymstoku
• Journal: Progress in Health Sciences
• Year: 2014
• Volume: 4
• Issue: 1
• Pages: 61-67

Contributors

author

D. Tomczyk

author

A. Jander

author

J. Mihailescu

author

M. Tkaczyk

References

• Grenda R. Mykofenolan mofetilu w leczeniu zespołu nerczycowego u dzieci. Forum Nefrol. 2013; 6(2):130-4.
• Ostalska-Nowicka D, Malinska A, Silska M, Perek B, Zachwieja J, Nowicki M. Mycophenolate mofetil (MMF) treatment efficacy in children with primary and secondary glomerulonephritis. Arch Med Sci. 2011 Dec 31;7(6):1042-8.
• Nickavar A, Safarzadeh AE, Sotoudeh K, Otukesh H, Hooman N. Mycophenolate mofetil for treatment of idiopathic nephrotic syndrome in children. Iran J Kidney Dis. 2012 Sep;6(5):346 -9.
• Kwinta-Rybicka J, Wilkosz K, Wierzchowska-Słowiacze EK, Ogarek I, Moczulska A, Stec Z, Pełkowska A, Sancewicz-Pach K, Pietrzyk JA. Mycophenolate mofetil in treatment of childhood nephrotic syndrome – preliminary report. Przegl Lek. 2006;63(3):44-8. (Polish)
• KDIGO clinical practice guidelines for glomerulonephritis. Kidney Int. 2012; 2(S2): 139-274.
• Gargah TT, Lakhoua MR. Mycophenolate mofetil in treatment of childhood steroid-resistant nephrotic syndrome. J Nephrol. 2011 Mar-Apr;24(2):203-7.
• Hogg RJ, Fitzgibbons L, Bruick J, Bunke M, Ault B, Baqi N, Trachtman H, Swinford R. Mycophenolate mofetil in children with frequently relapsing nephrotic syndrome: a report from the Southwest Pediatric Nephrology Study Group. Clin J Am Soc Nephrol. 2006 Nov;1(6):1173-8.
• Dorresteijn EM, Kist-van Holthe JE, Levtchenko EN, Nauta J, Hop WC, van der Heijden AJ. Mycophenolate mofetil versus cyclosporine for remission maintenance in nephrotic syndrome. Pediatr Nephrol. 2008 Nov;23(11):2013-20.
• Klinger M, Durlik M. Zastosowanie MMF w pierwotnych kłębuszkowych zapaleniach nerek. Nefrol Dial Pol. 2009;13:67-70.
• Fujinaga S, Ohtomo Y, Umino D, Takemoto M, Shimizu T, Yamashiro Y, Kaneko K. A prospective study on the use of mycophenolate mofetil in children with cyclosporine-dependent nephrotic syndrome. Pediatr Nephrol. 2007 Jan; 22(1):71-6.
• Fujinaga S, Ohtomo Y, Hirano D, Nishizaki N, Someya T, Ohtsuka Y, Kaneko K, Shimizu T. Mycophenolate mofetil therapy for childhood-onset steroid dependent nephrotic syndrome after long-term cyclosporine: extended experience in a single center. Clin Nephrol. 2009 Oct;72(4):268-73.
• Briggs WA, Choi MJ, Scheel PJ Jr. Successful mycophenolate mofetil treatment of glomerular disease. Am J Kidney Dis. 1998 Feb;31(2):213-7.
• Banerjee S, Pahari A, Sengupta J, Patnaik SK. Outcome of severe steroid-dependent nephrotic syndrome treated with mycophenolate mofetil. Pediatr Nephrol. 2013 Jan;28(1):93-7.
• Baudouin V, Alberti C, Lapeyraque AL, Bensman A, André JL, Broux F, Cailliez M, Decramer S, Niaudet P, Deschênes G, Jacqz-Aigrain E, Loirat C. Mycophenolate mofetil for steroid-dependent nephrotic syndrome: a phase II Bayesian trial. Pediatr Nephrol. 2012 Mar;27(3):389-96
• Nikibakhsh AA, Mahmoodzadeh H, Karamyyar M, Hejazi S, Noroozi M, Macooie AA. Treatment of steroid and cyclosporine-resistant idiopathic nephrotic syndrome in children. Int J Nephrol. 2011;2011:930965.
• Hassan AV, Sinha MD, Waller S. A single-center retrospective study of the safety and efficacy of mycophenolate mofetil in children and adolescents with nephrotic syndrome. Clin Kidney J. 2013 Aug;6(4):384-89.
• Li Z, Duan C, He J, Wu T, Xun M, Zhang Y, Yin Y. Mycophenolate mofetil therapy for children with steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2010 May;25(5):883-8.
• Okada M, Sugimoto K, Yagi K, Yanagida H, Tabata N, Takemura T. Mycophenolate mofetil therapy for children with intractable nephrotic syndrome. Pediatr Int. 2007 Dec;49(6):933-7.
• Echeverri CV, Valencia GA, Higuita LM, Gayubo AK, Rosas LF, Muňoz LC, Sierra J, Zuleta JJ, Ruiz JJ. Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience. J Bras Nefrol. 2013 Jul-Sep;35(3):200-5.
• Barletta GM, Smoyer WE, Bunchman TE, Flynn JT, Kershaw DB. Use of mycophenolate mofetil in steroid-dependent and -resistant nephrotic syndrome. Pediatr Nephrol. 2003 Aug;18(8):833-7.