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Treatment with mycophenolate mofetil and prednisolone for steroid-dependent nephrotic syndrome

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Abstract

The management of patients with steroid-dependent nephrotic syndrome (SDNS) refractory to treatment with long-term steroids, levamisole and cyclophosphamide is difficult. We report our experience on long-term treatment with mycophenolate mofetil (MMF) and alternate-day prednisolone in 42 patients with SDNS previously treated with levamisole (n = 35) and/or cyclophosphamide (n = 37). The mean age (range) at onset of nephrotic syndrome was 37 (13–92) months and at treatment with MMF 104.7 (32–187) months. MMF was administered at a mean daily dose of 26.5 (16.6–31.3) mg/kg for 14.3 (6–45) months. The mean 6-monthly relapse rates decreased from 3.0 episodes before therapy to 0.9 episodes in the first 6 months, 0.7 in next 6 months, and 0.3 in those treated longer than 12 months (P < 0.0001). While on therapy, 32 (76.2%) patients showed 50% or more reduction in relapse rates, and nine (21.4%) had sustained remission. The cumulative dose of prednisolone declined significantly from 0.6 mg/kg per day before to 0.3 mg/kg per day while receiving MMF. Prednisolone requirement was reduced by 50% or more in 16 patients and between 40% and 50% in eight patients. Treatment continuation beyond 12 months resulted in sustained steroid sparing and reduced need for alternative treatments while maintaining low relapse rates. No patients had diarrhea, hematological abnormalities, or impaired renal function. This data confirms the efficacy and safety of treatment with MMF and tapering doses of alternate-day prednisolone in patients with SDNS and supports its use for longer than 12 months.

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References

  1. Thorban S, Schwarznau A, Huser N, Stangl M (2006) Efficacy of conventional immunosuppressive therapy in related and unrelated living renal transplantation. Clin Transplant 20:284–288

    Article  CAS  Google Scholar 

  2. Pisoni CN, Karim Y, Cuadrado MJ (2005) Mycophenolate mofetil and systemic lupus erythematosus: an overview. Lupus 14 (Suppl 1):S9–S11

    Article  CAS  Google Scholar 

  3. D’Cruz DP (2005) Mycophenolate mofetil in systemic vasculitis. Lupus 14 (Suppl 1):S55–S57

    Article  Google Scholar 

  4. Frisch G, Lin J, Rosenstock J, Markowitz G, D’Agati V, Radhakrishnan J, Preddie D, Crew J, Valeri A, Appel G (2005) Mycophenolate mofetil (MMF) vs placebo in patients with moderately advanced IgA nephropathy: a double blind randomized controlled trial. Nephrol Dial Transplant 20:2139–2145

    Article  CAS  Google Scholar 

  5. Cattran DC (2003) Mycophenolate mofetil and cyclosporine therapy in membranous nephropathy. Semin Nephrol 23:272–277

    Article  CAS  Google Scholar 

  6. Bagga A, Mantan M (2005) Nephrotic syndrome in children. Indian J Med Res 122:13–28

    PubMed  Google Scholar 

  7. Mendizabal S, Zamora I, Berbel O, Sanahuja MJ, Fuentes J, Simon J (2005) Mycophenolate mofetil in steroid/cyclosporine-dependent/resistant nephrotic syndrome. Pediatr Nephrol 20:914–919

    Article  CAS  Google Scholar 

  8. Moudgil A, Bagga A, Jordan SC (2005) Mycophenolate mofetil therapy in frequently relapsing steroid-dependent and steroid-resistant nephrotic syndrome of childhood: current status and future directions. Pediatr Nephrol 20:1376–1381

    Article  Google Scholar 

  9. Hogg RJ, Fitzgibbons L, Bruick J, Bunke M, Ault B, Baqi N, Trachtman H, Swinford R (2006) Mycophenolate mofetil in children with frequently relapsing nephrotic syndrome: A report from the Southwest Pediatric Nephrology Study Group. Clin J Am Soc Nephrol 1:1173–1178

    Article  CAS  Google Scholar 

  10. Gellermann J, Querfeld U (2004) Frequently relapsing nephrotic syndrome: treatment with mycophenolate mofetil. Pediatr Nephrol 19:101–104

    Article  Google Scholar 

  11. Bagga A, Hari P, Moudgil A, Jordan SC (2003) Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome. Am J Kidney Dis 42:1114–1120

    Article  CAS  Google Scholar 

  12. Indian Pediatric Nephrology Group, Indian Academy of Pediatrics (2001) Consensus statement on management of steroid sensitive nephrotic syndrome. Indian Pediatr 38:975–986

    Google Scholar 

  13. Bagga A, Hari P, Srivastava RN (1999) Prolonged versus standard prednisolone therapy for initial episode of nephrotic syndrome. Pediatr Nephrol 13:824–827

    Article  CAS  Google Scholar 

  14. Bagga A, Sharma A, Srivastava RN (1997) Levamisole therapy in corticosteroid-dependent nephrotic syndrome. Pediatr Nephrol 11:415–417

    Article  CAS  Google Scholar 

  15. Centers for Disease Control and Prevention, National Center for Health Statistics. CDC growth charts: United States http://www.cdc.gov/growthcharts/May 30, 2000

  16. Fujinaga S, Ohtomo Y, Umino D, Takemoto M, Shimizu T, Yamashiro Y, Kaneko K (2007) A prospective study on the use of MMF in children with cyclosporine dependent nephrotic syndrome. Pediatr Nephrol 22:71–76

    Article  Google Scholar 

  17. Barletta GM, Smoyer WE, Bunchman TE, Flynn JT, Kershaw DB (2003) Use of mycophenolate mofetil in steroid-dependent and -resistant nephrotic syndrome. Pediatr Nephrol 18:833–837

    Article  Google Scholar 

  18. Morath C, Schwenger V, Beimler J, Mehrabi A, Schmidt J, Zeier M, Muranyi W (2006) Antifibrotic actions of mycophenolic acid. Clin Transplant 20 (Suppl 17):25–29

    Article  Google Scholar 

  19. Al-Akash S, Al-Makdama A (2005) Mycophenolate mofetil in children with steroid-dependent and/or frequently relapsing nephrotic syndrome. Ann Saudi Med 25:380–384

    Article  Google Scholar 

  20. Novak I, Frank R, Vento S, Vergara M, Gauthier B, Trachtman H (2005) Efficacy of mycophenolate mofetil in pediatric patients with steroid-dependent nephrotic syndrome. Pediatr Nephrol 20:1265–1268

    Article  Google Scholar 

  21. Dorresteijn E, Kist-van Holthe J, Levtchenko E, Nauta J, Hop W, Van der Hejden A (2007) Randomized controlled trial of mycophenolate mofetil versus cyclosporine A in children with frequently relapsing nephrotic syndrome. Pediatr Nephrol 22:1442 (28 FC)

    Google Scholar 

  22. Jeong H, Kaplan B (2007) Therapeutic monitoring of mycophenolate mofetil. Clin J Am Soc Nephrol 2:184–191

    Article  CAS  Google Scholar 

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Acknowledgements

Kamran Afzal was supported by the International Pediatric Nephrology Association for short-term training at this center.

Collaboration between the All India Institute of Medical Sciences (New Delhi) and Cedars Sinai Medical Center (Los Angeles) was made possible through the Renal Sister Center Program Initiative of the International Society of Nephrology.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Kamran Afzal, Arvind Bagga, Shina Menon & Pankaj Hari

  2. Department of Pediatrics, Cedars Sinai Medical Center, UCLA, Los Angeles, CA, USA

    Stanley C. Jordan

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  1. Kamran Afzal
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  2. Arvind Bagga
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  3. Shina Menon
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  4. Pankaj Hari
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  5. Stanley C. Jordan
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Correspondence to Arvind Bagga.

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Afzal, K., Bagga, A., Menon, S. et al. Treatment with mycophenolate mofetil and prednisolone for steroid-dependent nephrotic syndrome. Pediatr Nephrol 22, 2059–2065 (2007). https://doi.org/10.1007/s00467-007-0617-9

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  • DOI: https://doi.org/10.1007/s00467-007-0617-9

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