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NDT Advance Access published online on November 7, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm538
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Mycophenolate mofetil or standard therapy for membranous nephropathy and focal segmental glomerulosclerosis: a pilot study

Lakshmanan Senthil Nayagam1, Anirban Ganguli1, Manish Rathi1, Harbir S. Kohli1, Krishan L. Gupta1, Kusum Joshi2, Vinay Sakhuja1 and Vivekanand Jha1

1Department of Nephrology and 2Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence and offprint requests to: Dr Vivekanand Jha, Additional Professor of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India. Email: vjha{at}pginephro.org



  Abstract

Background. The current treatment regimes for patients with nephrotic syndrome due to idiopathic membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) are based on steroids and/or cytotoxic agents. Data on the effect of mycophenolate mofetil (MMF) for these conditions are scarce and confounding.

Methods. We compared the efficacy of an MMF-based therapy with standard therapies in inducing remission in adult nephrotics with MN and FSGS in a randomized pilot study. MMF was given at 2 g/day for 6 months along with prednisolone at 0.5 mg/kg/day for 2–3 months. Conventional therapy was prednisolone 1 mg/kg/day for 3–6 months for FSGS and alternating monthly cycles of steroids and cyclophosphamide for 6 months for MN. The primary end point was change in urinary protein/creatinine ratio.

Results. A total of 54 patients (21 MN and 33 FSGS) were recruited; 28 were randomized to receive MMF (group A) and 26 were on conventional treatment (group B). There was no difference in the proportion of patients achieving remission in two groups (64 and 80% in MN and 70 and 69% in FSGS). The frequency of relapses and incidence of infections was also similar. FSGS patients in group A achieved remission faster and received a lower cumulative steroid dose.

Conclusions. A 6-month treatment with MMF is as effective as the conventional treatment for primary treatment of MN and FSGS in the short term. It induces remission faster and reduces steroid exposure in FSGS patients. Studies with more cases and longer follow-up are required to evaluate its impact on preservation of kidney function.

Keywords: controlled trial; focal segmental glomerulosclerosis; membranous nephropathy; mycophenolate mofetil; outcome

Received for publication: 10. 5.07
Accepted in revised form: 16. 7.07


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