The Mycophenolate Mofetil Therapy in Corticoresistent Idiopathic Focal Segmental Glomerulosclerosis

Abstract

The Focal Segmental Glomerulosclerosis (FSGS) is one of the most frequent glomerular nephropathies affecting both children and adults. The aim of this study is the evaluation of the effects of Mycophenolate Mofetil (MMF) in Nephrotic Syndrome (NS) with biopsy proven Focal Segmental Glomerulosclerosis (FSGS) resistant to other therapies. We treated 20 patients, of which 12 males, with a median age of 39 years (ranging between 18 and 62 years), with Nephrotic Syndrome, all being resistant to or relapsing on steroid and immunosuppressive therapy. They were treated with MMF (1-2 g/day) and Methylprednisolone 0.5 mg/kg at alternate days for an average period of ten months (ranging between 3 and 13 months). Two patients discontinued treatment after three and five months respectively, for gastric intolerance. Another patient discontinued MMF after six months due to deterioration of kidney function. No significant differences were observed between pretreatment values and at the end of the treatment for plasma creatinine, Glomerular Filtration Rate (GFR), while the excretion rate of urinary proteins was significantly reduced from 7.68 ± 3.54 to 3.20 ± 2.92 g/day, (p<0.001). After MMF we observed a complete remission in two patients (10%), an incomplete remission in three patients (15%), a partial remission in six patients (30%), no response in eight patients (40%) and a worsening of kidney function in one patient (5%). It was concluded that in resistant Nephrotic Syndrome by FSGS, MMF can favor stable remission, preserving renal function and hence being considered as an alternative therapy to calcineurin inhibitors, but with lower toxicity.