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  • Title: Mycophenolate mofetil in the treatment of glomerular diseases.
    Author: Grcevska L, Polenakovic M.
    Journal: Prilozi; 2007 Jul; 28(1):57-68. PubMed ID: 17921918.
    Abstract:
    AIM: Treatment of primary glomerular diseases may be unsuccessful or have potential toxicities. Mycophenolate mofetil (MMF) is a new, relatively non-toxic drug. It has been introduced as an immunosuppressive drug, but it also has effects on non-immune cells (vascular smooth muscle cells, fibrocytes). Therefore, we evaluated the use of MMF for the treatment of glomerular diseases at different stages of the disease. METHODS: The daily dosage of MMF was 2 for the first 6 months and 1.5 g for a further 18 months, combined with steroids. The follow-up period was two years. RESULTS: 18 patients with lupus nephritis were treated. Patients with a high histological activity index showed a significant decrease of serum creatinine (p < 0.05) and proteinuria (p < 0.01), while patients with a high chronicity index showed only a decrease of proteinuria (p < 0.05). 15 patients with membranous nephropathy were treated. They showed stable renal function and a significant decrease of proteinuria (p < 0.05). Complete remission was achieved only in patients with MMF as a first choice drug. 4 patients with focal segmental glomerulosclerosis did not show any significant decrease of proteinuria, while the nephrotic syndrome in minimal change nephropathy (3 patients) showed a complete recovery. Partial improvement of the nephrotic syndrome was noted in 5 patients with membranoproliferative glomerulonephritis and in 4 patients with crescentic glomerulonephritis. Patients with crescentic glomerulonephritis also presented a significant decrease of serum creatinine (p < 0,05). MMF in 3 patients with IgA nephropathy grade I showed a significant improvement of the nephrotic syndrome. In grade III (5 patients) the response was partial. CONCLUSIONS: We can conclude that MMF in our patients showed both actions, as an immunosuppressive drug in the early stages of the disease, and as an anti-fibrotic agent in the chronic phase of the disease.
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