Mycophenolate mofetil (MMF) therapeutic approach in patients with chronic glomerulonephritis (GN)

Abstract

To the Editor: In a recent issue of Kidney International, Dr. Levin[1.Levin M.L. Mycophenolate mofetil treatment for primary glomerular diseases.Kidney Int. 2002; 62: 1475Crossref PubMed Scopus (6) Google Scholar] presented successful treatment of patients with membranoproliferative glomerulonephritis (GN) using mycophenolate mofetil (MMF). We obtained contradictory results using MMF in five patients with resistant nephrotic syndrome (NS) during primary GN. MMF (1 g two times daily) was administered to patients as a second approach medication Table 1. Before MMF therapy, patients were treated with corticosteroids and cyclophosphamide or cyclosporin. Along with MMF, the patients received hypolipemic treatment, angiotensin-converting enzyme (ACE) inhibitors, and small doses of corticosteroids. In the patients, creatinine clearance was normal and stable over a period of several years before introduction of MMF. Positive response was observed in one patient, while in the other four, even an increase in proteinuria was observed, despite prolongation of the treatment up to 18 months. In the patient with diagnosis of focal segmental glomerulosclerosis (FSGS), a marked rise in proteinuria and a decrease in creatinine clearance was observed, with aggravation of renal insufficiency requiring dialysis a year and a half after discontinuation of therapy. The only MMF-sensitive patient in our study was a female with a 13-year history of renal disease who continued to be in remission one year after the MMF treatment was concluded. Results of our study are, therefore, substantially different from earlier reports[2.Briggs W.A. Choi M.J. Scheel P.J. Successful mycophenolate mofetil treatment of glomerular disease.Am J Kidney Dis. 1998; 31: 213-217Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar, 3.Choi M.J. Eustace J.A. Gimenez L.F. et al.Mycophenolate mofetil treatment for primary glomerular diseases.Kidney Int. 2002; 61: 1098-1114Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar]. The coexisting major lipid and protein disorders, along with low gammaglobulin concentrations, were likely to contribute to increased risk of infections, which resulted in an increase of proteinuria and resistance to treatment. In light of the above, the use of MMF in treatment of primary GN remains controversial.Table 1Characteristics of patients before and after MMF therapyProteinuria g/24hoursCreatinine clearance mL/minSerum protein g/dLSerum albumin g/dLPatient age/genderDiagnosis/duration of disease yearsBeforeAfterBeforeAfterBeforeAfterBeforeAfterE.W. 24/MMGN 38.59.41081015.04.02.72.0B.M. 25/FFSGS 46.21499505.03.82.51.6M.S. 23/FMGN 135.42.01001246.06.63.04.3I.W. 28/MFSGS 161010.82001895.85.63.13.0J.K. 19/FMGN 24.76.483703.64.42.32.4Abbreviations are: MGN, mesangial proliferative glomerulonephritis; MMF, mycophenolate mofetil; FSGS, focal segmental glomerulosclerosis. Open table in a new tab Abbreviations are: MGN, mesangial proliferative glomerulonephritis; MMF, mycophenolate mofetil; FSGS, focal segmental glomerulosclerosis.