Skip to main content

Advertisement

SpringerLink
Log in

Frequently relapsing nephrotic syndrome: treatment with mycophenolate mofetil

  • Brief Report
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Long-term treatment with cyclosporin A (CyA) of children with frequently relapsing steroid-sensitive nephrotic syndrome (SSNS) carries the risk of nephrotoxicity. We have analyzed renal function in 23 children with SSNS during CyA therapy. Repeated measurements of glomerular filtration rate (single-shot 51Cr-EDTA clearance) showed a decline from 131±21 ml/min per 1.73 m2 to 116±27 ml/min per 1.73 m2 at last follow-up. Similarly, effective renal plasma flow (simultaneous 123I-hippurate clearance) was correlated with duration of CyA treatment, and showed a decline from 980±318 ml/min per 1.73 m2 to 724±242 ml/min per 1.73 m2. In a pilot study we investigated the effect of mycofenolate mofetil (MMF) in 7 children with a median age of 12.7 years [6 with minimal change nephrotic syndrome (MCNS), 1 with focal segmental glomerulosclerosis (FSGS)] with signs of nephrotoxicity because of long-term CyA therapy. Only 1 patient with SSNS showed a relapse during MMF therapy. In the patient with FSGS, MMF was started in addition to CyA, resulting in complete remission for a follow-up of 28 months. This preliminary study demonstrates that children with MCNS treated with CyA may be successfully converted to MMF without major side effects. In all cases, including FSGS, MMF had a beneficial effect on renal function. These data should be confirmed by a prospective randomized clinical trial.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Rothenberg MB, Heymann W (1957) The incidence of the nephrotic syndrome in children. Pediatrics 19:446–452

    PubMed  Google Scholar 

  2. Schlesinger ER, Sulz HA, Mosher WE, Feldman JC (1968) The nephrotic syndrome. Its incidence and implications for the community. Am J Dis Child 116:623–632

    CAS  PubMed  Google Scholar 

  3. Clark AG, Barratt TM (1999) Steroid-responsive nephrotic syndrome. In Baratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology, 4th edn. Lippincott, Williams and Wilkins, Baltimore, pp 731–747

  4. Nash MA, Edelman CM Jr, Bernstein J, Barnett HL (1992) Minimal change nephrotic syndrome, diffuse mesangial hypercellularity and focal glomerulosclerosis. In: Edelmann CM Jr (ed) Pediatric kidney disease, 2nd edn. Little Brown, Boston, pp 1267–1290

  5. Ehrich JHH, Brodehl J, Arbeitsgemeinschft für Pädiatrische Nephrologie (1993) Long versus standard prednisolone therapy for initial therapy of idiopathic nephrotic syndrome in children. Eur J Pediatr 152:357–361

    CAS  PubMed  Google Scholar 

  6. Durkan AM, Hodson EM, Willis NS, Craig JC (2001) Immunosuppression agents in childhood nephrotic syndrome: a meta-analysis of randomized controlled trials. Kidney Int 59:1919–1927

    Article  CAS  PubMed  Google Scholar 

  7. Baratt TM, Bercowsky A, Osfsky SG, Soothill JF, Kay R (1975) Cyclophosphamide treatment in steroid-sensitive relapsing nephrotic syndrome of childhood. Lancet I:55–58

    Google Scholar 

  8. Garin EH, Pryor ND, Fennell RS, Richard GA (1978) Pattern of response to prednisolone in idiopathic minimal lesion nephrotic syndrome as a criterion in selecting patients for cyclophosphamide therapy. J Pediatr 92:304–308

    CAS  PubMed  Google Scholar 

  9. Arbeitsgemeinschaft für Pädiatrische Nephrologie (1987) Cyclophosphamide treatment of steroid dependent nephrotic syndrome: comparison of eight week with 12 week course. Arch Dis Child 62:1102–1106

    PubMed  Google Scholar 

  10. Tenbrock K, Muller-Berghaus J, Fuchshuber A, Michalk D, Querfeld U (1998) Levamisole treatment in steroid-sensitive and steroid-resistant nephrotic syndrome. Pediatr Nephrol 12:459–462

    Article  CAS  PubMed  Google Scholar 

  11. Hulton SA, Jadresic L, Shah V, Trompeter RS, Dillon MJ, Baratt TM (1994) Effect of cyclosporine A on glomerular filtration rate in children with minimal change nephritic syndrome. Pediar Nephrol 8:404–407

    Google Scholar 

  12. Weber LT, Shipkova M, Armstrong VW, Wagner N, Schutz E, Mehls O, Zimmerhackl LB, Oellerich M, Tönshoff B (2002) The pharmacokinetic-pharmacodynamic relationship for total and free mycophenolic acid in pediatric renal transplant recipients: a report of the German study group on mycophenolate mofetil therapy. J Am Soc Nephrol 13:759–768

    PubMed  Google Scholar 

  13. Briggs WA, Choi MJ, Scheel PJ Jr (1998) Successful mycophenolate mofetil treatment of glomerular disease. Am J Kidney Dis 31:213–217

    CAS  PubMed  Google Scholar 

  14. Badid C, Desmouliere A, Laville M (2001) Mycophenolate mofetil: implications for the treatment of glomerular disease. Nephrol Dial Transplant 16:1752–1756

    Article  CAS  PubMed  Google Scholar 

  15. Chandra M, Susin M, Abitol C (2000) Remission of relapsing childhood nephrotic syndrome with mycophenolate mofetil. Pediatr Nephrol 14:224–226

    Article  CAS  PubMed  Google Scholar 

  16. Montane B, Abitbol C, Paredes A, Zilleruelo G, Strauss J (1999) Mycophenolate mofetil (MMF) treatment in steroid resistant/relapsing nephrotic syndrome (NS) of childhood. J Am Soc Nephrol 10:111A

    Google Scholar 

  17. Bartosh SM (1999) The use of mycophenolate mofetil in children with nephrotic syndrome. J Am Soc Nephrol 10:95A

    Google Scholar 

  18. Hüsemann D, Gellermann J, Vollmer I, Ohde I, Devaux S, Ehrich JHH, Filler G (1999) Long-term prognosis of hemolytic uremic syndrome and effective renal plasma flow. Pediatr Nephrol 13:672–677

    Article  CAS  PubMed  Google Scholar 

  19. Schulz E, Shipkova M, Armstong VW, Niedmann PD, Weber L, Tönshoff B, Pethig K, Wahlers T, Braun F, Ringe B, Oellerich M (1998) Therapeutic drug monitoring of mycophenolic acid: comparison of HPLC and immunoassay reveals new MPA metabolites. Transplant Proc 30:1185–1187

    Google Scholar 

  20. Habib R, Niaudet P (1994) Comparison between pre- and posttreatment renal biopsies in children receiving cyclosporine for idiopathic nephrosis. Clin Nephrol 42:141–146

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, Charité University Children’s Hospital, Augustenburger Platz 1, 13353 Berlin, Germany

    Jutta Gellermann & Uwe Querfeld

Authors
  1. Jutta Gellermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uwe Querfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jutta Gellermann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gellermann, J., Querfeld, U. Frequently relapsing nephrotic syndrome: treatment with mycophenolate mofetil. Pediatr Nephrol 19, 101–104 (2004). https://doi.org/10.1007/s00467-003-1300-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-003-1300-4

Keywords

Search

Navigation