Combination therapy with mycophenolate mofetil and prednisone in steroid-resistant idiopathic membranoproliferative glomerulonephritis

Abstract

To observe the efficacy of the combination therapy of mycophenolate mofetil (MMF) and glucocorticoids on steroid-resistant idiopathic membranoproliferative glomerulonephritis (IMPGN) with moderate to heavy proteinuria. 13 cases were diagnosed as IMPGN by renal biopsy after excluding secondary etiology. 9 patients had heavy proteinuria and another 4 with moderate proteinuria, 9 with hypertension and 11 with decreased renal function. Before MMF therapy, all of them were resistant to treatment of glucocorticoid (prednisone 1 mg/kg/d) for 8 weeks or more. The initial dose of MMF was 1.5 g/d. Patients were followed up every month, including blood pressure, urine protein excretion, liver and kidney function, complete blood count, and adverse events recorded. At the initiation, the 24-h urine protein excretion was 4.1 +/- 1.4 g, serum creatinine (Scr) 131.0 +/- 44.9 mmol/l, and estimated glomerular filtration rate (eGFR) 63.3 +/- 26.8 ml/min/1.73 m(2). After prednisone therapy for at least 2 months, the 24-h urine protein excretion and eGFR did not change significantly (p > 0.05). After 3 months of the addition of MMF, 24-h urine protein excretion decreased slightly to 3.8 +/- 1.2 g (p < 0.05),Scr decreased to 127.3 +/- 43.7 micromol/l and eGFR elevated to 65.7 +/- 26.8 ml/min/1.73 m(2), (p < 0.05); after 6 months, 24-h urine protein excretion decreased more significantly (2.5 +/- 0.9 g, p < 0.01), with improved kidney function (Scr 97.2 +/- 27.3 mmol/l and eGFR 81.3 +/- 24.2 ml/min/1.73 m(2), p < 0.01); compared with that before MMF treatment. After 12 months, 24-h urine protein excretion decreased further (1.5 +/- 0.6g, p < 0.01) with kidney function remained stable (Scr 95.9 +/- 22.5 micromol/l and eGFR 81.2 +/- 23.8 ml/min/1.73 m(2)). MMF combined with glucosteroids could effectively decrease proteinuria and improve renal function on steroid-resistant IMPGN. Further study with a large sample is needed to evaluate the efficacy and safety of MMF in the treatment of IMPGN.