Department of Paediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poland.
Arch Med Sci. 2011 Dec 31;7(6):1042-8. doi: 10.5114/aoms.2011.26618. Epub 2011 Dec 30.
The aim of our study was to analyse the efficacy and safety of mycophenolate mofetil (MMF) as part of the complex immunosuppressive therapy in children with different types of primary and secondary glomerulonephritis, who were not eligible for the standard treatment routine suggested by evidence-based guidelines.
The study group comprised 85 children with proteinuric glomerulopathies hospitalized between 2007 and 2010, who were non-responders to immunosuppressive therapy. The dose of MMF was established as 1 g/m(2)/24 h. Remission was defined as negative proteinuria in three consecutive urinalyses.
The patients were divided into 4 groups: idiopathic nephrotic syndrome (n = 35), primary glomerulonephritis (n = 15), auto-antibody associated glomerulonephritis (n = 20) and lupus nephropathy (LN, n = 15). Ten patients from the first group (29%) and 5 patients each from the second and third group (34% and 25% respectively) did not respond to MMF therapy. On the other hand, all the children diagnosed with LN have reached clinical and biochemical remission.
Alternative rescue MMF therapy should always be taken into consideration in proteinuric patients who are non-responders to steroids, cyclosporine A and cyclophosphamide in whom the initial glomerular filtration rate is higher than 60 ml/min/1.73m(2). It is recommended that MMF be administered as part of the standard treatment regimen in patients diagnosed with lupus nephropathy. In these groups of patients, the potent benefits of this therapy are higher than expected side-effects.
我们研究的目的是分析霉酚酸酯（MMF）作为复杂免疫抑制治疗的一部分在患有不同类型原发性和继发性肾小球肾炎的儿童中的疗效和安全性，这些儿童不符合循证指南建议的标准治疗方案。
研究组包括 2007 年至 2010 年间住院的 85 例蛋白尿性肾小球病变患儿，他们对免疫抑制治疗无反应。MMF 的剂量设定为 1g/m²/24h。缓解定义为连续三次尿液分析均为阴性蛋白尿。
患者分为 4 组：特发性肾病综合征（n=35）、原发性肾小球肾炎（n=15）、自身抗体相关肾小球肾炎（n=20）和狼疮性肾炎（LN，n=15）。第一组 10 例患者（29%）和第二组和第三组各 5 例患者（34%和 25%）对 MMF 治疗无反应。另一方面，所有诊断为 LN 的儿童均达到临床和生化缓解。
对于初始肾小球滤过率高于 60ml/min/1.73m²的对激素、环孢素 A 和环磷酰胺无反应且蛋白尿的患者，应始终考虑替代救援 MMF 治疗。建议将 MMF 作为狼疮性肾炎患者标准治疗方案的一部分。在这些患者群体中，这种治疗的强大益处高于预期的副作用。
