Nadal Miguel Angel, Lococo Bruno, Fazzini Maria Bernarda, Gonzalez Gabriela, Otero Alcira Beatriz, Malvar Ana Valeria
Daomi Institute, Buenos Aires, Argentina.
Clin Nephrol. 2013 Jun;79(6):439-44. doi: 10.5414/CN107915.
Treatment of patients with resistant/relapsed adult nephrotic syndrome (RNS) caused by glomerulopathies has no consensus therapy.
This is a retrospective analysis (RA), performed on 55 patients with RNS treated during one year with enteric coated sodium mycophenolate (EC-MPS) and reduced corticosteroids doses.
Inclusion criteria for this RA were: patients aged ≥ 18 years old, diagnosed with RNS with histologically proven glomerulopathy who had received standard therapy with enalapril and/or losartan and 10 mg per day or 20 mg of prednisone every other day. NS was defined with the following criteria: proteinuria > 3.5 g/day, serum albumin ≤ 3 g/dl, hypercholesterolemia and edema. Treatment consisted of oral EC-MPS in 360 mg tablets, 720 mg bid, together with prednisone 10 mg daily or 20 mg every other day. Effectiveness was assessed as the rate of response in the cohort: complete, partial or absent. Complete response patients: 24 hours proteinuria < 300 mg/day, partial response patients: proteinuria > 300 mg/day and < than 3 g/day, all the rest were considered as non responders.
response was achieved in 40/55 (73%) of patients, 24 (44%) with complete response and 16 (29%) with partial response. No EC-MPS discontinuation has been observed due to adverse events, except for one case of transient interruption of medication for 2 weeks.
EC-MPS as single therapy with minimal doses of corticosteroids as in this RA could be an effective alternative in the treatment of patients with RNS.
对于由肾小球病引起的成人耐药/复发肾病综合征（RNS）患者，尚无共识性治疗方案。
这是一项回顾性分析（RA），对55例在一年内接受肠溶包衣霉酚酸钠（EC-MPS）和减量皮质类固醇治疗的RNS患者进行。
该RA的纳入标准为：年龄≥18岁，诊断为RNS且经组织学证实为肾小球病，已接受依那普利和/或氯沙坦标准治疗，每日服用10mg或隔日服用20mg泼尼松。NS的定义如下：蛋白尿>3.5g/天、血清白蛋白≤3g/dl、高胆固醇血症和水肿。治疗包括口服360mg片剂的EC-MPS，每日两次，每次720mg，同时每日服用10mg泼尼松或隔日服用20mg泼尼松。有效性评估为队列中的缓解率：完全缓解、部分缓解或无缓解。完全缓解患者：24小时蛋白尿<300mg/天，部分缓解患者：蛋白尿>300mg/天且<3g/天，其余均视为无反应者。
55例患者中有40例（73%）实现缓解，24例（44%）完全缓解，16例（29%）部分缓解。除1例药物短暂中断2周外，未观察到因不良事件而停用EC-MPS的情况。
如本RA中所示，EC-MPS作为单一疗法并联合最小剂量的皮质类固醇，可能是治疗RNS患者的有效替代方案。
