Efficacy of mycophenolate treatment in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome
Sandoval, Diego (Hospital Universitari de Bellvitge)
Poveda, Rafael (Hospital Universitari de Bellvitge)
Draibe, Juliana (Hospital Universitari de Bellvitge)
Pérez-Oller, Laureà (Hospital General de Vic)
Díaz Encarnación, Montserrat Mercedes (Institut d'Investigació Biomèdica Sant Pau)
Ballarín Castan, José Aurelio (Institut d'Investigació Biomèdica Sant Pau)
Saurina, Anna (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Marco, Helena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bonet Sol, Josep (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Barros, Xoana (Hospital Universitari de Girona Doctor Josep Trueta)
Fulladosa, Xavier (Hospital Universitari de Bellvitge)
Torras, Joan (Hospital Universitari de Bellvitge)
Cruzado, Josep María (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Fecha:	2017
Resumen:	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). 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 (1500mg/day in one patient) or 1440 mg/day for sodium MF. The initial prednisone (PDN) dose was 10mg/day in 14 patients, 5mg/day in two patients and no steroids in one patient. In the remaining 12 patients, moderate initial doses of PDN were administered (mean: 23. 7mg/day, range: 15-40), tapering to 10mg/day after 1month. 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 38months (4-216). Regarding complications, only minor digestive disorders and a slight decrease in blood haemoglobin levels were observed in a few patients. 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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Immunosuppresion ; Minimal change disease ; Mycophenolate mofetil ; Nephrotic syndrome ; Steroids
Publicado en:	Clinical Kidney Journal, Vol. 10 Núm. 5 (january 2017) , p. 632-638, ISSN 2048-8513

DOI: 10.1093/ckj/sfx035
PMID: 28979773

7 p, 437.7 KB

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