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Clin Kidney J. 2017 Oct;10(5):632-638. doi: 10.1093/ckj/sfx035. Epub 2017 Apr 27.

Efficacy of mycophenolate treatment in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome.

Author information

1
Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
2
Department of Nephrology, Hospital General de Vic, Vic, Catalunya, Spain.
3
Renal and Hypertension Unit, Fundació Puigvert de Barcelona, Barcelona, Spain.
4
Department of Nephrology, Hospital de Terrassa, Terrassa, Catalunya, Spain.
5
Department of Dialysis, Hospital Germans Trias i Pujol de Badalona, Barcelona, Spain.
6
Department of Nephrology, Hospital Josep Trueta de Girona, Girona, Catalunya, Spain.

Abstract

BACKGROUND:

This study assessed the efficacy of therapy with mycophenolate (MF) and reduced doses of steroids in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome (SD/FR-INS).

METHODS:

Twenty-nine nephrotic patients (including 16 males and 13 females; mean age: 40 years, range: 18-74) were treated. Starting doses of MF were 2000 mg/day for mofetil MF (1500 mg/day in one patient) or 1440 mg/day for sodium MF. The initial prednisone (PDN) dose was 10 mg/day in 14 patients, 5 mg/day in two patients and no steroids in one patient. In the remaining 12 patients, moderate initial doses of PDN were administered (mean: 23.7 mg/day, range: 15-40), tapering to 10 mg/day after 1 month.

RESULTS:

Nephrotic syndrome remission was achieved in 27/29 cases (93.1%) (25 complete, 2 partial). Two patients showed resistance to the prescribed schedule. The first cycle of MF therapy was concluded in 20 patients after a mean (range) of 16.9 months (12-49). Maintenance of remission was observed in 11 of these 20 cases (55%) after a mean follow-up of 32.8 months (12-108). In nine patients with nephrotic syndrome relapse after tapering of MF (MF dependency), the same MF-PDN schedule was restarted, leading again to remission in all nine. The remaining seven MF-sensitive patients are still receiving their first therapeutic cycle. To date, the mean time under therapy in the 27 MF-sensitive patients is 38 months (4-216). Regarding complications, only minor digestive disorders and a slight decrease in blood haemoglobin levels were observed in a few patients.

CONCLUSIONS:

MF plus reduced doses of PDN is an effective and well-tolerated therapy for adult SD/FR-INS. Though MF dependence is observed, its low toxicity could allow long periods of therapy if it is required to maintain nephrotic syndrome remission.

KEYWORDS:

immunosuppresion; minimal change disease; mycophenolate mofetil; nephrotic syndrome; steroids

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