IS MYCOPHENOLATE MOFETIL THE ANSWER FOR PROBLEMATIC NEPHROTICS?
Dr. H. SATISH*, Dr. R. PRAGNYA**, Dr. M. VIJAYAKUMAR***, Dr. B.R. NAMMALWAR****
Department of Pediatric Nephrology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai *, Department of Pediatric Nephrology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai **, Department of Pediatric Nephrology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai ***, Department of Pediatric Nephrology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai****
Introduction
Nephrotic syndrome (NS) is a common chronic glomerular disease. Its outcome was considered mostly benign until recently. With longtime experience, it has been found that a significant number do progress to end stage renal disease (ESRD). The response to steroids determines the outcome rather than the histology. Newer drugs are being tried for prevention of this progression to ESRD in children with steroid resistant NS (SRNS). Mycophenolate mofetil (MMF) is one such immunosuppressive agent. We present a preliminary report on our experience with MMF in children with NS.
Aim
To present our clinical experience of MMF in children with SRNS and steroid dependent NS (SDNS).
Materials and Methods
Seven patients with SRNS and four patients with SDNS were included in this study. Histologically, 5 patients had minimal change NS (MCNS), 3 had diffuse mesangial proliferation (DMP) and 3 had focal segmental glomerulosclerosis (FSGS). The number of relapses ranged from 8 to 12. All these children had received an initial course of oral prednisolone as per the German Pediatric Association recommendation. Steroid-resistant children were given 5 doses of IV methyl prednisolone followed by 6 injections of cyclophosphamide at monthly intervals along with oral prednisolone at 1 mg/kg on alternate days for one year. Children with SDNS were given oral prednisolone with either oral cyclophosphamide for 12 weeks or oral levamisole for 6 to 12 months. Relapses were treated with 2 weeks of daily steroid therapy at 60 mg/m2 BSA, followed by 40 mg/m2 BSA of alternate day steroids for 4 weeks. When all these measures failed, these children were administered MMF in a dose of 50 mg/kg in 2 divided doses along with oral prednisolone at 1 mg/kg on alternate days for one year.
Results
Four children have completed one year of MMF and 3 among them are under remission while one child continues to be proteinuric. Of the 3 children who are under remission, 2 had MCNS and one had FSGS histology. The remaining seven children have completed nine months of MMF and all of them continue to be proteinuric. No significant changes were detected in the mean serum creatinine level. During the follow up period, no significant infections, hematological or hepatic dysfunction were observed.
Conclusion
In this preliminary study, no significant cure seems to be derived from the use of MMF in most of the SRNS and SDNS. However, MMF does provide a partial control of proteinuria and has a steroid sparing effect. These features along with its safety profile are its advantages, but the cost is the prohibitive factor for its frequent usage.
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SATISH H D, PRAGNYA R D, VIJAYAKUMAR M D, NAMMALWAR B D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=48
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