The effect of mycophenolate mofetil on primary and secondary treatment of primary glomerulonephritis and lupus nephritis.

Background: Mycophenolate mofetil (MMF) has shown to be a reliable choice in the treatment of glomerulonephritis. We retrospectively reviewed the clinical course and response to MMF therapy in 49 patients with primary glomerulopathy (37 patients) and lupus nephritis [class III (five patients) and IV (seven patients)].

Methods: Patients were treated with MMF for more than 6 months as a primary (18 patients) or an adjunctive treatment (31 patients). Patients were also on methylprednisolone (2-20 mg/day) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker.

Results: The mean age of the patient cohort was 33.69 +/- 12.4 years (range 19-59 years). Twenty-four-hour urinary protein excretion was reduced from 3.50 +/- 3.08 g prior to the commencement of MMF drug therapy to 1.21 +/- 1.44 and 0.99 +/- 1.34 g at the sixth and 12th months of MMF therapy, respectively (P < 0.05 for all). During this same period, significant increases in serum total protein (from 5.92 +/- 1.38 to 6.59 +/- 0.79 and 6.81 +/- 0.77 g/dl) and albumin levels (from 3.23 +/- 1.10 to 3.93 +/- 0.67 and 4.21 +/- 0.50 g/dl) were detected, whereas total cholesterol and low-density lipoprotein levels were found to be significantly decreased (P < 0.05 for all). Serum creatinine levels did not significantly change. The efficacy of MMF in reducing proteinuria was similar in both first line and an adjunctive therapy. The efficacy of MMF therapy began at the third month of treatment and continued through to the 12th month.

Conclusion: Mycophenolate mofetil therapy was found to be useful in achieving improvements in proteinuria and nephrotic syndrome and stabilizing renal function. It was also a well-tolerated drug by the majority of the patients. Based on our results, we suggest that MMF may be alternative therapy for resistant/relapsing primary glomerulopathies and lupus nephritis.