Mycophenolate mofetil or standard therapy for membranous nephropathy and focal segmental glomerulosclerosis: a pilot study

Nayagam, Lakshmanan Senthil; Ganguli, Anirban; Rathi, Manish; Kohli, Harbir Singh; Gupta, Krishan Lal; Joshi, Kusum; Sakhuja, Vinay; Jha, Vivekanand

doi:10.1093/ndt/gfm538

Cited by 80 publications

(61 citation statements)

References 28 publications

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“…Cyclosporin plus lowdose prednisone was shown in a randomized, controlled trial to be superior to prednisone alone in preserving renal function assessed as creatinine clearance (102). Mycophenolate mofetil has not been tested as monotherapy for FSGS, but it has been tested in combination with glucocorticoids in three trials against active comparators that were either glucocorticoids or cyclosporin (reviewed in Senthil Nayagam et al [103]). None of the trials showed significant differences between groups, and although sample sizes were small, particularly for noninferiority trials, these data suggest efficacy.…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Focal Segmental Glomerulosclerosis

Rosenberg

Kopp

2017

CJASN

385

348

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Focal segmental glomerulosclerosis (FSGS) is a leading cause of kidney disease worldwide. The presumed etiology of primary FSGS is a plasma factor with responsiveness to immunosuppressive therapy and a risk of recurrence after kidney transplant-important disease characteristics. In contrast, adaptive FSGS is associated with excessive nephron workload due to increased body size, reduced nephron capacity, or single glomerular hyperfiltration associated with certain diseases. Additional etiologies arenow recognized asdrivers of FSGS: high-penetrance geneticFSGSdue to mutations in one of nearly 40 genes, virus-associated FSGS, and medication-associated FSGS. Emerging data support the identification of a sixth category: APOL1 risk allele-associated FSGS in individuals with sub-Saharan ancestry. The classification of a particular patient with FSGS relies on integration of findings from clinical history, laboratory testing, kidney biopsy, and in some patients, genetic testing. The kidney biopsy can be helpful, with clues provided by features on light microscopy (e.g., glomerular size, histologic variant of FSGS, microcystic tubular changes, and tubular hypertrophy), immunofluorescence (e.g., to rule out other primary glomerulopathies), and electron microscopy (e.g., extent of podocyte foot process effacement, podocyte microvillous transformation, and tubuloreticular inclusions). A complete assessment of renal histology is important for establishing the parenchymal setting of segmental glomerulosclerosis, distinguishing FSGS associated with one of many other glomerular diseases from the clinical-pathologic syndrome of FSGS. Genetic testing is beneficial in particular clinical settings. Identifying the etiology of FSGS guides selection of therapy and provides prognostic insight. Much progress has been made in our understanding of FSGS, but important outstanding issues remain, including the identity of the plasma factor believed to be responsible for primary FSGS, the value of routine implementation of genetic testing, and the identification of more effective and less toxic therapeutic interventions for FSGS.

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Section: Therapeutic Approachesmentioning

confidence: 99%

Focal Segmental Glomerulosclerosis

Rosenberg

Kopp

2017

CJASN

385

348

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“…Risk of bias was assessed for the three included RCTs, and details are provided in Table 2. The overall risk of bias was low in Gipson et al 44 , but unclear in Senthil Nayagam et al 24 and Xiao et al 23 Treatment outcomes…”

Section: Description Of Studies and Risk Of Bias Assessmentmentioning

confidence: 97%

“…(2) MMF as add-on therapy (a) RCTs The three included RCTs all evaluated MMF as a complement to routine treatments of primary FSGS 23,24,44 ( Table 3).…”

Section: Description Of Studies and Risk Of Bias Assessmentmentioning

confidence: 99%

“…(ii) MMF þ prednisolone versus prednisolone In this RCT with unclear risk of bias, Senthil Nayagam et al 24 recruited 33 biopsy confirmed primary FSGS adult patients for a 12-month trial, in which 17 of them were allocated to the MMF þ prednisolone group; 16 were allocated to the prednisolone group. The trial also recruited membranous nephropathy patients, but only data from primary FSGS patients were included in this review.…”

Section: Description Of Studies and Risk Of Bias Assessmentmentioning

confidence: 99%

“…MMF acts through its inhibition on the inosine monophosphate dehydrogenase, which reduces T and B lymphocyte proliferation. 21 Antidotal benefits of MMF in treating primary FSGS patients have been reported, [22][23][24] but clinical evidence on the efficacy and safety of MMF has not been summarized. We performed a systematic review on the use of MMF for the treatment of primary FSGS, either alone or as complement to current routine treatments.…”

Section: Introductionmentioning

confidence: 99%

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