Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome

Bagga, Arvind; Hari, Pankaj; Moudgil, Asha; Jordan, Stanley C.

doi:10.1053/j.ajkd.2003.08.011

Cited by 122 publications

(93 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…MMF has attracted much attention in this regard. MMF has been successfully used in the management of many primary glomerulopathies (24), but there are limited data on the effectiveness of MMF in MCD (25)(26)(27)(28). Experience with tacrolimus for MCD is also very limited.…”

Section: Discussionmentioning

confidence: 99%

Adult Minimal-Change Disease

Waldman

Crew²,

Valeri³

et al. 2007

Clinical Journal of the American Society of Nephrology

361

439

View full text Add to dashboard Cite

Minimal-change disease (MCD) counts for 10 to 15% of cases of primary nephrotic syndrome in adults. Few series have examined this disease in adults. A retrospective review was performed of 95 adults who had MCD and were seen at a single referral center. Examined were presenting features, response to daily versus alternate-day steroids, response to second-line agents, relapse patterns, complications of the disease and therapy, presence of acute renal failure (ARF), and outcome data. Sixty-five patients received daily and 23 received alternate-day steroids initially. There were no differences in remissions, time to remission, relapse rate, or time to relapse between daily-and alternate-day-treated patients. More than one quarter of patients were steroid resistant. At least one relapse occurred in 73% of patients; 28% were frequently relapsing. A significant proportion of frequently relapsing patients became steroid dependent. Second-line agents were used for steroid dependence, steroid resistance, or frequent relapses. No single agent proved superior. There were more remissions with second-line agents in steroid-dependent patients compared with steroid-resistant patients, and remissions were more likely to be complete in steroid-dependent patients. ARF occurred in 24 patients; they tended to be older and hypertensive with lower serum albumin and more proteinuria than those without ARF. At follow up, patients with an episode of ARF had higher serum creatinine than those without ARF. Four patients progressed to ESRD. These patients were less likely to have responded to steroids and more likely to have FSGS on repeat renal biopsy. In this referral MCD population, response to daily and alternate-day steroids is similar. Second-line agents give greater response in patients who are steroid dependent. ARF occurs in a significant number of adult MCD patients and may leave residual renal dysfunction. Few patients progress to ESRD. M inimal-change disease (MCD) is the most common cause of the nephrotic syndrome (NS) in children. It accounts for 70 to 90% of the NS in children who are younger than 10 yr and 50% in older children. It is also an important cause of primary NS in adults of all ages, accounting for 10 to 15% of cases (1,2). Although there are many data regarding the course, response to treatment, and outcomes in pediatric patients, only a few series have examined these issues in adults (3-8). Relatively less is known about the presentation of MCD in adult patients, response to agents other than steroids, the risk for acute renal failure (ARF), and the long-term outcome. Moreover, most series of adults with MCD have not been in US populations, and it is unknown whether the features and course of the disease are the same in differing parts of the world.We therefore performed a retrospective review of 95 patients who had primary adult-onset MCD and were treated at a single tertiary care center in the past 15 yr. Many of the patients were referred by outside nephrologists for opinions regarding treatment. This review...

show abstract

Section: Discussionmentioning

confidence: 99%

Adult Minimal-Change Disease

Waldman

Crew²,

Valeri³

et al. 2007

Clinical Journal of the American Society of Nephrology

361

439

View full text Add to dashboard Cite

show abstract

“…One patient permanently stopped MMF because of an ANC of 300/mm 3 . Within 8 d, her ANC normalized to 4600/ mm 3 . Four other patients had mild decreases in the ANC.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…CsA is associated with nephrotoxicity in some patients. Preliminary data from a series of pediatric (1)(2)(3)(4)(5)(6)(7)(8) and adult (9 -11) studies suggest that mycophenolate mofetil (MMF) may represent a less toxic alternative for patients with FRNS. Other recent studies have reported that mizoribine (12)(13)(14)(15)(16)(17) or levamisole (18) also may be options to consider in such patients.…”

mentioning

confidence: 99%

Mycophenolate Mofetil in Children with Frequently Relapsing Nephrotic Syndrome

Hogg¹,

Fitzgibbons²,

Bruick³

et al. 2006

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Children with frequently relapsing nephrotic syndrome (FRNS) often develop adverse effects from prednisone. Attempts to induce long-term remission in such patients have had varying levels of success. In this multicenter, prospective, open-label study, 14 centers enrolled 33 patients with FRNS, all of whom were in remission at the time of entry. Six of the patients were steroid dependent. The patients received mycophenolate mofetil (MMF) 600 mg/m 2 twice daily (maximum 1 g twice daily) for 6 mo. A tapering dosage of alternate-day prednisone was given to each patient during the first 16 wk of MMF therapy. Patients were monitored for relapses of NS during and after MMF therapy. Treatment failure was defined as a relapse of NS. The patients had the following features at study entry: Age 6.8 ؎ 2.7 yr (range 2 to 15 yr); 56% male, 44% female; and 50% white; 25% black, and 25% other. Estimated GFR at entry was 138 ؎ 42 ml/min per 1.73 m 2 . Twenty-four (75%) of 32 patients stayed in remission throughout the 6 mo of MMF therapy. The relapse rate in these patients improved from one episode every 2 mo before MMF to one every 14.7 mo after MMF. Eight patients stayed in remission during the post-MMF period, for periods of 18 to 30 mo, whereas 16 relapsed after stopping MMF. Eight (25%) of 32 patients relapsed while taking MMF. It is concluded that MMF is effective for maintaining remission in patients who have FRNS and receive treatment for at least 6 mo and is associated with a low incidence of adverse events.

show abstract

“…45,[48][49][50][51][52][53][54][55][56] In total, they enrolled 52 biopsy-proven primary FSGS patients and the follow-up ranged from 12 weeks to 47 months. All of the ten studies recruited patients who were dependent on or resistant to current routine therapies.…”

Section: Low Riskmentioning

confidence: 99%

“…All of the ten studies recruited patients who were dependent on or resistant to current routine therapies. For the types of corticosteroids, five studies used prednisolone 48,51,52,54,55 ; four used prednisone 45,50,53,56 and one did not specify the type of corticosteroid used. 49 The outcomes of the 10 studies are as follows (Table 3):…”

Section: Low Riskmentioning

confidence: 99%

Mycophenolate mofetil for primary focal segmental glomerulosclerosis: systematic review

Lau

et al. 2013

Renal Failure

View full text Add to dashboard Cite

Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome

Cited by 122 publications

References 15 publications

Adult Minimal-Change Disease

Adult Minimal-Change Disease

Mycophenolate Mofetil in Children with Frequently Relapsing Nephrotic Syndrome

Mycophenolate mofetil for primary focal segmental glomerulosclerosis: systematic review

Contact Info

Product

Resources

About