Abstract
Background: Mycophenolate mofetil (MMF) has been shown to be a well-tolerated drug which could maintain prolonged remission in patients with steroid dependent nephrotic syndrome (SDNS). MMF is known to have a steroid sparing effect. Objectives: To determine the effect of MMF in reducing relapses in Sri Lankan children with SDNS and to ascertain the incidence of side effects of MMF in this population. Method: Children between 1-18 years of age with SDNS who had been treated with MMF for 12 months or more at the paediatric nephrology unit, Teaching Hospital Peradeniya, were selected and reviewed retrospectively. Children who had previously received immunosuppressive therapy other than prednisolone, cyclophosphamide, cyclosporin A, tacrolimus and levamisole and those who were on MMF for indications other than idiopathic nephrotic syndrome were excluded. Children and parents were interviewed and their patient-held health records, including their ‘nephrotic syndrome diary’ were reviewed. Data were collected twice a week using pretested questionnaires, in the nephrotic syndrome clinic for a period of 8 weeks. Results were analysed using SPSS version 23. Results:Thirty five children who met the selection criteria were included. Of them 26 (74.3%) were male and 09 (25.7%) were female. The median age was 9.7 years. Mean number of relapses in the year before starting MMF and the year after starting MMF were 3.5 and 1.8 respectively. The reduction in the relapse rate after being on MMF was significant (p=0.009). Child’s age or gender did not impact the relapse rate (p>0.05). The most common side effect observed was cough (20%) and the least common ones were abdominal pain, dyspnoea and dizziness (3%). Conclusions: In this study MMF reduced relapse rates of children with SDNS, despite some minor side effects.
Highlights
Nephrotic syndrome (NS) is the commonest glomerular disorder in children[1]
Children who had previously received immunosuppressive therapy other than prednisolone, cyclophosphamide, cyclosporin A, tacrolimus and levamisole and those who were on Mycophenolate mofetil (MMF) for indications other than idiopathic nephrotic syndrome were excluded
The reduction in the relapse rate after being on MMF was 1Accident and Emergency Unit, Sirimavo Bandaranayake Specialized Children’s Hospital, Peradeniya, Sri Lanka, 2Department of Paediatrics, University of Peradeniya, Sri Lanka *Correspondence: sandahetti@gmail.com (Received on 23 April 2018: Accepted after revision on 29 June 2018) The authors declare that there are no conflicts of interest Personal funding was used for the project
Summary
Nephrotic syndrome (NS) is the commonest glomerular disorder in children[1]. Histologically, minimal change disease (MCD) is found in about 80% of childhood NS2. NS becomes frequently relapsing or steroid dependent in about 20% to 60% of patients, resulting in poor quality of life of patients and their families[4]. It complicates the treatment course for the clinician[4]. There are several second line treatment options in this group of patients, amongst which mycophenolate mofetil (MMF) is a relatively new medication[5]. Mycophenolate mofetil (MMF) has been shown to be a well-tolerated drug which could maintain prolonged remission in patients with steroid dependent nephrotic syndrome (SDNS).
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