López HJT, Olalde CR, Serviño MPE

Language: Spanish
References: 37
Page: 80-86
PDF size: 514.43 Kb.

ABSTRACT

Background: The chronic glomerulonephritis (primary and secondary) is the result of several inflammatory and immunological processes and is the second cause of chronic renal insufficiency. The mycophenolate mofetil has an immunologic effect by inhibiting the production of B and T lymphocytes and it also stimulates as well the intraglomerular cell proliferation.
Objective: To determine the response to mycophenolate mofetil in pediatric patients with chronic glomerulonephritis resistant to steroids and several immunosuppressor drugs (cyclophosphamide and azathioprine).
Material and methods: We performed a systematic review with a prospective, descriptive and longitudinal study at the Centro Médico Nacional 20 de Noviembre ISSSTE in the Nephrology Department. Eight pediatric patients were included (ages 1-16 years) with primary or secondary chronic glomerulonephritis resistant to combined steroids and immunosuppressor drugs.
Results: We used mycophenolate mofetil with a mean dose of 30 mg/kg/day. We report an important decrease in the proteinuria nephropathy and partial remission of it in 2 patients. In those patients diagnosed with lupus, we observed and association between the use of mycophenolate mofetil and an increase in circulating complement levels.
Conclusions: Around 71% of our population had a reduced intensity of the proteinuria. In those patients with renal involvement in systemic erythematosus lupus, the elevated circulating C4 levels that they presented were reflected in a decrease of the proteinuria intensity with partial remission. The elevated level of C3 also showed control on the extra-renal clinical manifestations of systemic lupus erythematosus.

REFERENCES

1. Falk RJ, Jennette JC, Nachman PH. Glomerulopatías primarias. En: Brenner BM. Brenner & Rector’s, editor. El riñón. Tratado de Nefrología. Volumen 1. Madrid: Elsevier, 2005.

2. Hricik DE, Chung-Park M, Sedor JR. Glomerulonephritis. NEJM 1998;339:888-899.

3. Badid Ch, Desmouliere A, Laville M. Mycophenolate mofetil: implications for the treatment of glomerular disease. Nephrol Dial Transplant 2001;16:1752-1756.

4. Roberti I, Reisman L. A comparative analysis of the use of mycophenolate mofetil in pediatric vs adult renal allograft recipients. Pediatr Transplantation 1999;3:231-235.

5. Ahsan N, Hricik D, Matas A, Rose S, et al. Prednisone withdrawal in kidney transplant recipients on cyclosporine and micophenolate mofetil-a prospective randomized study. Transplantation 1999;68:1865-1874.

6. Kimball JA, Pescovitz MD, Book BK, Norman DJ, et al. Reduced human IgG anti-ATGAM antibody formation in renal transplant recipients receiving mycophenolate mofetil. Transplantation 1995;60:1379-1383.

7. Knoll GA, MacDonald I, Khan A, Van Walraven C. Mycophenolate mofetil dose reduction and the risk of acute rejection after renal transplantation. J Am Soc Nephrol 2003;14:2381-2386.

8. Wang K, Zhang H, Li Y, Wei Q, et al. Safety of mycophenolate mofetil versus azathioprine in renal transplantation: A systematic review. Transplant Proc 2004;36:2068-2070.

9. Allison AC. Mechanisms of action of mycophenolate mofetil in preventing chronic rejection. Transplant Proc 2002;34:2863-2866.

10. Bayazit AK, Noyan A, Cengiz N, Anarat A. Mycophenolate mofetil in children with multidrug-resistant nephrotic syndrome. Clinical Neprhol 2004;61:25-29.

11. Dooley MA, Cosio FG, Nachman PH, Falkenhain ME, et al. Mycophenolate mofetil therapy in lupus nephritis: Clinical observations. J Am Soc Nephrol 1999;10:833-839.

12. Chan TM, Li KF, Tang CSO, Mok MY, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. NEJM 2000;19(343):1156-1162.

13. Lewis MJ, D’Cruz D. Adhesion molecules, mycophenolate mofetil and systemic lupus erythematosus. Lupus 2005;14:s17-s26.

14. European Mycophenolate Mofetil Cooperative Study Group. Placebo/controlled study of mycophenolate mofetil combined with cyclosporine and corticosteroids for prevention of acute rejection. Lancet 1995;345:1321-1325.

15. Sollinger HG. For The US Renal Transplant Mycophenolate Mofetil Study Group. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. Transplantation 1995;60:225-232.

16. Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. A blinded, randomized, clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. Transplantation 1996;61:1029-1037.

17. Choi MJ, Eustace JA, Gimenez LF, Atta MG, et al. Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 2002;61:1098-1114.

18. Ziswiler R, Steinmann NK, Kappeler A, Daniel C, et al. Mycophenolic acid: A new approach to the therapy of experimental mesangial proliferative glomerulonephritis. J Am Soc Nephrol 1998;9:2055-2066.

19. Cattran DC, Wang MM, Appel G, Matalon A, et al. Mycophenolate mofetil in the treatment of focal segmental glomeruloesclerosis. Clin Nephrol 2004;62:405-411.

20. Karim MY, Alba P, Cuadrado MJ, Abbs IC, et al. Mycophenolato mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents. Rheumatology 2002;41:876-882.

21. Neumann I, Haidinger M, Jager H, Grutzmacher H, et al. Pharmacokinetis of mycophenolate mofetil in patients with autoimmune disease compared renal transplant recipients. J Am Soc Nephrol 2003;14:721-727.

22. Virji M, Carter JE, Lirenman DS. Single-center experience with mycophenolate mofetil in pediatric renal transplant recipients. Pediatr Transplantation 2001;5:293-296.

23. Letter to the editor. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. NEJM 2001;344:382-383.

24. Ginzler EM, Dooler MA, Aranow C, Kim MY, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. NEJM 2005;21:2219-2228.

25. Contreras G, Pardo V, Leclercq B, Lenz O, et al. Sequential therapies for proliferative lupus nephritis. NEJM 2004;350:971-980.

26. Kaptinsinou PP, Boletis JN, Skopouli F, Boki KA, et al. Lupus nephritis: treatment with mycophenolate mofetil. Rheumatology 2004;43:377-380.

27. Chan TK, Tse KCh, Tang CS, Mok MY, et al, for the Hong Kong Nephrology Study Group. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol 2005;16:1076-1084.

28. Pisoni CN, Karim Y, Cuadrado MJ. Mycophenolate mofetil and systemic lupus erythematosus an overview. Lupus 2005;14:s9-s11.

29. Chan TM, Wong WS, Lau CS, et al. Prolonged follow-up of patients with diffuse proliferative lupus nephritis treated with prednisone and mycophenolate mofetil. J Am Soc Nephrol. 12: 195A, 2001).

30. Baqi N, Moazami S, Singh A. Lupus nephritis in children: A longitudinal study of prognostic factors and therapy. J Am Soc Nephrol 1996;7:924-929.

31. Dooley MA, Hogan S, Jennette JF, Falk RJ. Cyclophosphamide therapy for lupus nephritis: Poor renal survival in black Americans. Kidney Int 1997;51:1188-1195.

32. Conlon PJ, Fischer CA, Levesque MC. Clinical, biochemical and pathological predictors of poor response to intravenous cyclophosphamide in patients with proliferative lupus nephritis. Clin Nephrol 1996;46:170-175.

33. Berden JH. Lupus nephritis (Nephrology Forum). Kidney Int 1997;52:538-558.

34. Austin III HA, Boumpas DT, Vaughan EM, Balow JE. Highrisk features of lupus nephritis: Importance of race and clinical and histological factors in 166 patients. Neprhol Dial Transplant 1995;10:1620-1628.

35. Cameron JS. The long-term outcome of glomerular diseases. In: Diseases of Kidney. Schrier RW, Gottschalk CW, editors. 6th ed. Boston: Little, Brown & Co., 1997;p:1965-1969.

36. Austin III HA, Boumpas DT, Vaughn EM, Balow JE. Predicting renal outcomes in severe lupus nephritis: Contributions of clinical and histologic data. Kidney Int 1994;45:544-545.

37. Ward MM, Studenski S. Clinical prognostic factors in lupus nephritis: The importance of hypertension and smoking. Arch Intern Med 1992;152:2082-2088.