Mycophenolate mofetil for primary focal segmental glomerulosclerosis: systematic review

Lau, Emily W Y; Ma, Haixia; Wu, Xinyin; Chung, Vincent C.H.; Wong, Samuel Yeung Shan

doi:10.3109/0886022x.2013.794687

Cited by 7 publications

(5 citation statements)

References 50 publications

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“…Subsequently, a randomized controlled trial including 138 patients (both children and adults) with primary FSGS compared CyA and MMF plus dexamethasone, but no difference was observed in complete or partial remission rates after 52 wk of followup and both groups showed poor outcome (remission in 46% vs 33%, respectively) [57] . At the present time, as reported by Lau et al [58] , no randomized controlled trial has yet to demonstrate the efficacy of MMF in association with other therapies or as a single agent in FSGS treatment on native or transplanted kidneys.…”

Section: Cyclophosphamide and Mycophenolate Mofetilmentioning

confidence: 83%

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Messina¹,

Gallo²,

Mella³

et al. 2016

WJT

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Focal segmental glomerulosclerosis (FSGS) represents one of the most severe glomerular diseases, with frequent progression to end-stage renal disease and a high rate of recurrence in renal allografts (30%-50%). Recurrent FSGS portends a negative outcome, with the hazard ratio of graft failure being two-fold higher then that of other glomerulonephritis. Two patterns of clinical presentations are observed: Early recurrence, which is characterized by massive proteinuria within hours to days after implantation of the renal graft, and late recurrence, which occurs several months or years after the transplantation. Many clinical conditions have been recognized as risk factors for recurrence, including younger age, rapid progression of the disease to end-stage renal disease on native kidneys, and loss of previous renal allografts due to recurrence. However, much less is known about the incidence and risk factors of the so-called "de novo " type of FSGS, for which sufferers are transplanted patients without disease on native kidneys; but, rapid development of allograft failure is frequently observed. Management of both forms is challenging, and none of the approaches proposed to date have been demonstrated as consistently beneficial or effective. In the present review we report an update on the available therapeutic strategies for FSGS in renal transplantation within the context of a critical overview of the current literature.

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Section: Cyclophosphamide and Mycophenolate Mofetilmentioning

confidence: 83%

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Messina¹,

Gallo²,

Mella³

et al. 2016

WJT

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“…Mycophenolate mofetil is also often used in current treatment regimens for patients with FSGS, primarily in children and adolescents. Results from RCT (Randomized Controlled Trial) revealed that MMF is not more effective than cyclosporine or CTX in preserving kidney function, when corticosteroid is used as baseline treatment …”

Section: Corticosteroids and Immunosuppressantsmentioning

confidence: 99%

“…Results from RCT (Randomized Controlled Trial) revealed that MMF is not more effective than cyclosporine or CTX in preserving kidney function, when corticosteroid is used as baseline treatment. 10…”

Section: Mycophenolate Mofetil (Mmf)mentioning

confidence: 99%

Advanced therapeutics in focal and segmental glomerulosclerosis

et al. 2018

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Focal segmental glomerulosclerosis (FSGS) is a glomerulonephritis with podocyte injury. The renal prognosis of FSGS is relative poor. The overall remission rate of the FSGS patients with nephrotic syndrome to immunosuppressive treatments was reported as 47–66%, highlighting its therapeutic challenge—lacking in sufficient evidence‐based interventions. In first‐line treatment of nephrotic syndrome, daily oral prednisolone is a commonly used drug, whereas optimal treatment strategies, like indications and duration, remain controversial. Calcineurin inhibitor and cyclophosphamide are recommended in steroid‐dependent/steroid‐resistant patients. However, the high unmet need in effective immunosuppressive treatments calls for the development of new therapy methods. Rituximab, a monoclonal antibody targeting CD20 B‐cells, could increase the complete or partial remission rate, and decrease the relapse rate based on several previous studies on FSGS. In addition, the using of rituximab could potentially help the FSGS patients to stop the concomitant therapy include steroid and immunosuppressive agents. Other treatment options like adalimumab or abatacept also showed potential therapeutic effect, but still required larger Randomized Controlled Trial study to determine its efficiency and safety. Besides, expanding understanding of the genetic basis of FSGS is necessary to investigate new therapeutic agents. With the unsatisfied patients’ outcome under the current treatments, innovation should be encouraged on the treatment strategy based on Kidney Disease: Improving Global Outcomes guideline and international collaborations are required for the potential novel immunosuppressive or immunomodulatory therapies.

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“…Therefore, it can be said that adding a vitamin ACE combination to MMF treatment provides a positive contribution to kidney functions and lipid profile. [41][42][43][44]…”

Section: Discussionmentioning

confidence: 99%

Effects of Cyclosporin A, Mycophenolate Mofetile, Vitamin A, D, E and N-Acetyl Systein in Rats With Nephrotic Syndrome

Baysal

2023

EJMA

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N ephrotic syndrome (NS) is a disease characterized by intense proteinuria, hypoalbuminemia, hyperlipidemia, and edema findings resulting from impaired protein permeability of glomeruli. Focal segmental glomerulosclerosis (FSGS), renal histology that is more common in patients with steroid-resistant nephrotic syndrome (SDNS), is a poor prognostic sign. The probability of response to the immunosuppressives used is low, and side effects are common. [1] Today, the use of complementary therapies is accepted in cas-es where there is no response to immunosuppressives. There is a need for new options that are effective and have no side effects in the treatment of NS. New immunosuppressives or new complementary therapies should be researched. [2] By using adriamycin on rats, an NS model with FSGS histology can be created. Adriamycin-induced NS pathogenesis includes apoptosis. Damage develops in the visceral epithelial cells of the glomeruli, resulting in severe proteinuria, glomerular sclerosis, and diffuse tubulointerstitial damage. [3,4] Objectives: Patients with steroid-resistant nephrotic syndrome have a high risk of developing chronic renal failure. Cyclosporine A used in treatment is nephrotoxic. Data on the efficacy of mycophenolate mofetil used in the treatment are insufficient. New treatment options should be explored. Our research aims to investigate the effectiveness of cyclosporine A, mycophenolate mofetil, vitamin A, D, E, N-acetyl cysteine and their combinations in rats with nephrotic syndrome. Methods: The research was conducted with 48 adult male rats of the Wistar-albino. To induce nephrotic syndrome, two doses of adriamycin were administered to all rats 20 days apart. Serum creatinine, albumin, cholesterol, triglyceride, total oxidant status, total antioxidant status, protein in urine, creatinine, and creatinine clearance were analyzed in rats. Glomerulosclerosis index, total injury score, interstitial fibrosis score, TGF-and osteopontin analyzes were performed within the scope of the histopathological evaluation. Results: At the end of the study, the lowest 24-hour urine protein was found in group B (cyclosporin A + vit ACE), and the highest 24-hour urine protein in group C (mycophenolate mofetil). The highest serum creatinine, triglyceride, and cholesterol and the lowest serum albumin levels are in group A (cyclosporine A). The lowest serum creatine, triglyceride, and cholesterol and the highest serum albumin levels are in group D (mycophenolate mofetil + vit ADE). Conclusion: It has been observed that vitamin ACE added to cyclosporine A treatment reduces cyclosporine A nephrotoxicity, and vitamin ACE added to mycophenolate mofetil contributes positively to renal histopathological findings.

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Mycophenolate mofetil for primary focal segmental glomerulosclerosis: systematic review

Cited by 7 publications

References 50 publications

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Advanced therapeutics in focal and segmental glomerulosclerosis

Effects of Cyclosporin A, Mycophenolate Mofetile, Vitamin A, D, E and N-Acetyl Systein in Rats With Nephrotic Syndrome

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