Revista de nefrología y terapéutica

Treatment of Steroid and Cyclophosphamide-Resistant Nephrotic Syndrome with Mycophenolate Mofetil and High Dose Dexamethasone (DEX)

Abstract

Sevgi Mir*,Seçil Conkar,Betül Sözeri,Kadriye Özdemir,Ä°pek Kaplan Bulut

Background: Clinicians often face with therapeutic challenges during the treatment of children with steroidresistant nephrotic syndrome (SRNS). The management of SRNS is primarily aimed at decreasing proteinuria and inducing remission. Mycophenolate mofetil (MMF) in combination with steroids is known to have some efficacy in the management of SRNS. The aim of this study is to evaluate the outcome of MMF/DEX therapy regimen.

Material and methods: We reported a prospectively longitudinal clinical series of patients with SRNS, all of whom have been treated with Mycophenolate mofetil and oral dexamethasone (DEX). We enrolled 29 children who were previously treated with steroid and cyclophosphamide at Ege University, Children’s Hospital. Treatment with MMF/DEX was administered for up to 52 weeks. These children were followed for a period of 2 years. Complete remission was defined as negative or trace proteinuria on urinalysis with a serum albumin level of >2.5 g/dl. On the other hand, partial remission was defined as a serum albumin level of >2.5 g/dl, but developing persistent proteinuria at non-nephrotic levels.

Results: Following the course of MMF/DEX, 68.9% (20/29) of children achieved a complete remission and 33.4% (1/29) remained at partial remission. After 24 months of follow- up, 55.1% (16/29) of children on MMF/DEX reached a complete remission and 13.7% (4/29) remained at partial remission.

Conclusion: MMF/DEX can be an effective and safe maintenance therapy among children with SRNS.