Medline ® Abstracts for References 123,124
of 'Treatment and prognosis of IgA nephropathy'
[A randomized control trial of mycophenolate mofeil treatment in severe IgA nephropathy].
Chen X, Chen P, Cai G, Wu J, Cui Y, Zhang Y, Liu S, Tang L
Zhonghua Yi Xue Za Zhi. 2002;82(12):796.
OBJECTIVE: To investigate the effectiveness safety and tolerance of mycophenolate mofeil(MMF) in severe IgA nephropathy and evaluate the dosage adjustment and course for clinical treatment.
METHODS: 62 patients with IgA nephropathy diagnosed by renal biopsy as Lee's grade IV and V with urinary protein>2.0 g/d were enrolled randomly in the trial. The initial dosage of MMF was 1.0 g/d (body weight<50 kg) or 1.5 g/d (body weight>50 kg). The dosage was reduced to 0.75 approximately 1.0 g/d after 6 months treatment, the maintaining dosage was 0.5 approximately 0.75 g/d after 12 months. The total course of treatment lasted at least 12 months. Another 31 patients matched with age gender and severity of renal damage were given prednisone orally (0.8mg(;)kg(;)d) (control group).Blood and urinary tests hepatic and renal function plasma albumin serum triglyceride and cholesterol 24 h protein excretion urinary NAG enzyme, creatinine clearance(Ccr) were performed before and 3 6 12 18 months after treatments in both groups 5 patients in MMF group received repeated renal biopsy.
RESULTS: (1) After 3 months treatment, decrease of urinary protein (1.9 g/24 h +/- 1.6 g/24 h vs 3.2 g/24 h +/- 1.7 g/24 h, P<0.01) and improvement of plasma albumin (41 g/L +/- 6 g/L vs 37 g/L +/- 6 g/L, P<0.01) were observed in MMF groups while in control group, no significant changes were found in uinary protein (2.3 g/24 h +/- 1.8 g/24 h vs 2.9 g/24 h +/- 1.5 g/24 h, P<0.05) and plasma albumin (40 g/L +/- 6 g/L vs 37 g/L +/- 6 g/L, P<0.05). After treatment for 6, 12 and 18 months, both group showed obvious alleviation of proteinuria and albumin. At the 12th and 18th month, the proteinuria in MMF group was significantly improved than that in control group (0.8 g/24 h +/- 0.8 g/24 h vs 1.4 g/24 h +/- 1.6 g/24 h and 0.6 g/24 h +/- 0.7 g/24 h vs 1.4 g/24 h +/- 1.3 g/24 h, P<0.05 respectively). The remission rate and total effective rate of MMF group were higher than those of the control group (44.4% vs 19.1% and 88.9% vs 61.9%, P<0.05 respectively). Patients were administered with MMF for 13.8 +/- 6.3 months (6 approximately 30 m). (2) Serum cholesterol and triglyceride were remarkably reduced after 6,12 and 18 months treatment in MMF group, no significant difference was found in control group(P<0.05). (3) For the 6 patients with renal insufficiency in MMF group, MMF treatment was significantly effective in 1 patient, effective in 2 patients, not effective in 3 patients with an overall effective rate of 50%. For the 7 patients with renal insufficiency in control group, the treatment was significantly effective in 1 patient, effective in 1 patient, not effective in 5 patients and total effective rate is 28.6%. (4) 5 patients in MMF group received repeated renal biopsy after 7 approximately 12 months treatment (mean 9.8 +/- 2.3 m). The results showed that the interstitial lesions were alleviated. No special drug-induced renal damage was obtained. (5) Side effects: 3 patients in MMF group suffered from slight diarrhea, 1 patient herpes zoster, all of them got remission without drug withdrawal. 1 patient suffered nausea in the first weeks. No significant change was found in hepatic function (P>0.05).
CONCLUSIONS: MMF is more effective in reducing proteinuria and serum lipid than the currently widespread use of prednisone therapy in IgA nephropathy patients with Lee SMK's grade IV approximately V and urinary protein>2.0 g/d. Treatment with MMF associates with less adverse effect and good tolerance.
Department of Nephrology General Hospital of Chinese PLA, Beijing 100853,China.
Long-term study of mycophenolate mofetil treatment in IgA nephropathy.
Tang SC, Tang AW, Wong SS, Leung JC, Ho YW, Lai KN
Kidney Int. 2010;77(6):543.
Since the efficacy of mycophenolate mofetil (MMF) to treat immunoglobulin A (IgA) nephropathy is controversial, we extended our original study by following 40 Chinese patients with established IgA nephropathy for 6 years. All patients were maintained on their angiotensin blockade medication and half were randomized to receive MMF for 6 months. After 6 years, 11 patients required dialysis (2 from the MMF and 9 from the control group). Significantly, only 3 treated (as compared to 10 control) patients reached the composite end point of serum creatinine doubling or end-stage renal disease. Linear regression showed the annualized decline in the estimated glomerular filtration rate was significantly less in the MMF-treated group. Urinary protein excretion and the albumin-to-creatinine ratio were lower with MMF treatment during the first 24 months, beyond which there was no difference between groups. Multivariable Cox regression analysis showed that the baseline estimated glomerular filtration rate and proteinuria, and change in the urine albumin-to-creatinine ratio at 1 year to be important predictors of progression to end-stage renal disease. We found that among Chinese patients with IgA nephropathy who had mild histologic lesions and persistent proteinuria despite maximal angiotensin blockade, MMF treatment may result in transient and partial remission of proteinuria in the short-term and renoprotection inthe long-term.
Nephrology Division, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China.