mycophenolate mofetil IN TREATMENT OF STEROID-RESISTANT NEPHROTIC SYNDROME IN CHILDREN


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Abstract

Aim. Assessment of efficacy and safety of micofenolat mofetil in treatment of primary steroid-resistant nephrotic syndrome in children.
Methods. 18 children with primary non-familial steroid-resistant nephrotic syndrome (7 patients with focal-segmental glomerulosclerosis, 7 - with mesangioproliferative glomerulonephritis, (GN), 3 - with minimal change nephrotic syndrome, 1 - with membranoproliferative GN) were included into the study. Mycophenolate mofetil was 31,8 mg/kg/24h was dispensed with methylprednisolone (0,5-1,0 mg/kg/48h).
Results. Complete clinical and laboratory remission was achieved in 22% of patients, partial - in 28%, 50% demonstrated no effect. Efficacy of micofenolat mofetil did not depend of morphological type of nephrotic syndrome. Adverse events were registered in 28% patients: immunodepression in 17%, anemia - in 11%.
Conclusion. Micofenolat mofetil сan induce complete or partial remission in 50% of children with steroid-resistant nephrotic syndrome

References

  1. Ehrich J.H.H., Geerlings C., Zivicnjak M. et al. Steroid-resistant idiopathic childhood nephrosis: overdiagnosed and undertreated. Nephrol Dial Transplant. 2007; 22: 2183-2193.
  2. Chesney R. The changing face of childhood nephrotic syndrome in children. Kidney Int. 2004; 6: 1294-1302.
  3. Kim J.S., Bellew C.A., Silverstein D.M. et al. High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney Int. 2005; 68: 1275-1281.
  4. Rio M., Kaskel F. Evaluation and management of steroid-unresponsive nephrotic syndrome. Current Opinion in Pediatrics 2008; 20: 151-156.
  5. Cattran D.C., Rao P. Long-term outcome in children and adults with classic focal segmental glomerulosclerosis. Am J Kidney Dis. 1998; 32: 72-79.
  6. Troyanov S., Wall C.A., Miller J.A. et al. Focal and segmental glomerulosclerosis: definition and relevance of a partial remission. J Am Soc Nephrol. 2005; 16: 1061-1068.
  7. Habashy D., Hodson E.M., Craig J.C. Interventions for steroid-resistant nephrotic syndrome: a systematic review. Pediatr Nephrol. 2003; 18: 906-912.
  8. Morris R.E., Wang J. Comparison of the immunosuppressive effects of mycophenolic acid and the morpholinoethylester of mycophenolic acid (RS-61443) in recipients of heart allografts. Transplant I Proc. 1991; 23: 493-496.
  9. Blaneta R.A., Leskel K., Wittig B. et al. Inhibition of endothelial receptor expression and of T-cell ligand activity by mycophenolate mofetil. Transpl Immunol. 1998; 6: 251-259.
  10. Briggs W.A., Сhoi M.J., Scheel P.J. Follow-up on mycophenolate mofetil treatment of glomerular diseases. Am J Kidney Dis. 1998; 31: 898-899.
  11. Hauser I.A., Renders L., Radeke H.H. еt al. Mycophenolate mofetil inhibits rat and human mesangial cell proliferation by guanosine depletion. Nephrol Dial Transplant. 1999; 14: 58-63.
  12. Allison A.C., Eugui E.M. Mycophenolate mofetil and its mechanisms of action. Immunopharmacology. 2000; 47: 85-118.
  13. Fujihara C.K., De L.N., Malheiros I. et al. Combined mycophenolate mofetil and losartan therapy arrests established injury in the remnant kidney. J Am Soc Nephrol. 2000; 11: 283-290.
  14. Dubus I., Vendrely B., Christophe I. et al. Mycophenolic acid antagonizes the activation of cultured human mesangial cells. Kidney Int. 2002: 62 (3): 857 - 867.
  15. Nankivell B.J., Wavamunno M.D., Borrows R.J. et al. Mycophenolate mofetil is associated with altered expression of chronic renal transplant histology. Am J Transplant. 2007; 7(2): 366-376.
  16. Chandra M., Susin M. Remission of relapsing childhood nephrotic syndrome with mycophenolate mofetil. Pediatr Nephrol. 2000; 14: 224-226.
  17. Bagga A., Hari P., Moudgil A., Jordan S.C. Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome. Am J Kidneу Dis. 2003; 42: 1114-1120.
  18. Gellerman J., Querfeld U. Frequently relapsing nephrotic syndrome: treatment with mycophenolate mofetil. Pediatr Nephrol. 2004; 19: 101-104.
  19. Novak I., Frank R., Vento S. et al. Efficacy of mycophenolate mofetil in pediatric patients with steroid-dependent nephrotic syndrome. Pediatr Nephrol. 2005; 20: 1265-1268.
  20. Afzal K., Bagga A., Menon S. et al. Treatment with mycophenolate mofetil and prednisolone for steroid-dependent nephrotic syndrome. Pediatr Nephrol. 2007; 22: 2059-2065.
  21. Fujinaga S., Ohtomo Y., Umino D. et al. A prospective study on the use of mycophenolate mofetil in children with cyclosporine-dependent nephrotic syndrome. Pediatr Nephrol. 2007; 22: 71-76.
  22. Dorresteijn E.M., Kist-van Holthe J.E., Levtchenko E.N. et al. Mycophenolate mofetil versus cyclosporine for remission maintenance in nephritic syndrome. Pediatr Nephrol. 2008; 23: 2013-2020.
  23. Barletta G.M., Smoyer W.E., Bunchman T.E. et al. Use of mycophenolate mofetil in steroid-dependent and resistant nephrotic syndrome. Pediatr Nephrol. 2003; 18: 833-837.
  24. Mendizabal S., Zamora I., Berbel O. et al. Mycophenolate mofetil in steroid/cyclosporine-dependent/resistant nephrotic syndrome. Pediatr Nephrol. 2005; 20: 914-919.
  25. Вознесенская Т.С., Сергеева Т.В. Мофетила микофенолат в терапии нефротического синдрома у детей. Нефрология и диализ. 2003; 5(1): 45-47.
  26. Приходина Л. С., Длин В.., Турпитко О. Ю. и соавт. Первый опыт использования мофетила микофенолата в лечении гломерулонефрита у детей. Нефрология и диализ. 2006; 8(1): 55-59.
  27. Канатбаева А. Б., Диканбаева С. А., Абеуова Б. А. и соавт. Микофенолата мофетил в терапии гломерулопатий у детей. Нефрология и диализ. 2006; 8(4): 355-358.
  28. De Mello V.R, Rodrigues M.T., Mastrocinque T.H. et al. Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome. Pediatr Nephrol. 2010; 25: 453-460.
  29. Li Z., Duan C., He J. et al. Mycophenolate mofetil therapy for children with steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2010; 25(5): 883-888.
  30. Schwartz G.J., Brion L.P., Spitzer A. The use of plasma creatinine concentration in for estimating glomerular filtration rate in infants, children and adolescents. Pediatr Clin North Am. 1987; 34: 571-590.
  31. National Kidney Foundation Kidney Disease Outcomes Quality Initiatives. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease Evaluation Classification Stratification. Am J Kidney Dis. 2002; 39(1): 1-266.
  32. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics. 2004; 114(2): 555-576.
  33. Ulinski T., Dubourg L., Saпd M.H. et al. Switch from cyclosporine A to mycophenolate mofetil in nephrotic children. Pediatr Nephrol. 2005; 20: 482-485.

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