Document Detail


Mycophenolate mofetil or standard therapy for membranous nephropathy and focal segmental glomerulosclerosis: a pilot study.
MedLine Citation:
PMID:  17989103     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The current treatment regimes for patients with nephrotic syndrome due to idiopathic membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) are based on steroids and/or cytotoxic agents. Data on the effect of mycophenolate mofetil (MMF) for these conditions are scarce and confounding.
METHODS: We compared the efficacy of an MMF-based therapy with standard therapies in inducing remission in adult nephrotics with MN and FSGS in a randomized pilot study. MMF was given at 2 g/day for 6 months along with prednisolone at 0.5 mg/kg/day for 2-3 months. Conventional therapy was prednisolone 1 mg/kg/day for 3-6 months for FSGS and alternating monthly cycles of steroids and cyclophosphamide for 6 months for MN. The primary end point was change in urinary protein/creatinine ratio.
RESULTS: A total of 54 patients (21 MN and 33 FSGS) were recruited; 28 were randomized to receive MMF (group A) and 26 were on conventional treatment (group B). There was no difference in the proportion of patients achieving remission in two groups (64 and 80% in MN and 70 and 69% in FSGS). The frequency of relapses and incidence of infections was also similar. FSGS patients in group A achieved remission faster and received a lower cumulative steroid dose.
CONCLUSIONS: A 6-month treatment with MMF is as effective as the conventional treatment for primary treatment of MN and FSGS in the short term. It induces remission faster and reduces steroid exposure in FSGS patients. Studies with more cases and longer follow-up are required to evaluate its impact on preservation of kidney function.
Authors:
Lakshmanan Senthil Nayagam; Anirban Ganguli; Manish Rathi; Harbir S Kohli; Krishan L Gupta; Kusum Joshi; Vinay Sakhuja; Vivekanand Jha
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-11-07
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  23     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-21     Completed Date:  2008-07-31     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  1926-30     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Cyclophosphamide / therapeutic use*
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Female
Follow-Up Studies
Glomerulonephritis, Membranous / diagnosis,  drug therapy*
Glomerulosclerosis, Focal Segmental / diagnosis,  drug therapy*
Humans
Kidney Function Tests
Male
Mycophenolic Acid / analogs & derivatives*,  therapeutic use
Pilot Projects
Prednisolone / therapeutic use*
Probability
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 24280-93-1/Mycophenolic Acid; 50-18-0/Cyclophosphamide; 50-24-8/Prednisolone; 9242ECW6R0/mycophenolate mofetil
Comments/Corrections
Comment In:
Nephrol Dial Transplant. 2008 Jun;23(6):1793-6   [PMID:  18441003 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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