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Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
Mycophenolate Mofetil in Primary Glomerulonephritis
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Mycophenolate Mofetil in Primary Glomerulonephritis

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Dr Chow Yok Wai …

Dr Chow Yok Wai
MSN 2007
Kuala Lumpur

Published in: Health & Medicine, Business
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  • 1. MYCOPHENOLATE MOFETIL IN THE TREATMENT OF PRIMARY GLOMERULONEPHRITIS Chow YW, Yahya R, Visvanathan R Department of Nephrology, Kuala Lumpur Hospital
  • 2. Objective Patients with primary glomerulonephritis (GN) Steroids or Cytotoxic agents Treatment resistance Frequent relapses
  • 3. Objective <ul><li>Mycophenolate mofetil (MMF) in addition to its immunosuppressive effects </li></ul><ul><ul><li>Inhibit vascular smooth muscle cell </li></ul></ul><ul><ul><li>Mesangial cell proliferation </li></ul></ul><ul><li> Ameliorate inflammation </li></ul><ul><li> Slow the progression in glomerular disease </li></ul><ul><li>We report our experience in using MMF for the treatment of primary GN. </li></ul>
  • 4. Design & Methods Four patients Focal Segmental Glomerulosclerosis (FSGS) Membranous nephropathy (MN) 3 1 Partial Response to Steroids and Cyclosporine Steroid Resistance No Response to Steroids and Cyclophosphamide 1 2 1
  • 5. Design & Methods <ul><li>MMF dose range </li></ul><ul><ul><li> 1.5-3.0g daily </li></ul></ul><ul><ul><li> at least 6 months </li></ul></ul><ul><li>24 hour urine protein </li></ul><ul><li>Serum albumin, </li></ul><ul><li>Serum creatinine, </li></ul><ul><li>Estimated GFR (eGFR) and </li></ul><ul><li>Serum cholesterol </li></ul><ul><ul><li>Start, 1, 3 and 6 months after MMF therapy were compared. </li></ul></ul>
  • 6. Definitions <ul><li>Complete remission </li></ul><ul><li>Urinary protein excretion less than 0.3g/24hours and </li></ul><ul><li>Normal serum albumin (>30g/L) and </li></ul><ul><li>Improved or stable renal function </li></ul><ul><li>Partial remission </li></ul><ul><li>Urinary protein excretion reduced by > 50% with range of 0.3-3.0g/24hours and </li></ul><ul><li>Serum albumin > 30g/L </li></ul>
  • 7. Definitions <ul><li>Progressive renal impairment </li></ul><ul><li>Rise in serum creatinine > 50umol/l or </li></ul><ul><li>Decrease in creatinine clearance exceeding 15% of baseline </li></ul><ul><li>Treatment failure </li></ul><ul><li>Persistent urinary protein excretion > 3g/24hours or </li></ul><ul><ul><ul><li>Progressive renal impairment within 12 months of starting therapy or </li></ul></ul></ul><ul><li>Permanent discontinuation of therapy as a result of drug side effects. </li></ul>
  • 8. Results <ul><li>Mean age of 37.23 + 19.72 years </li></ul>Telmisartan 80mg dly Enalapril 10mg dly 4 - Enalapril 20mg BD 3 Irbesartan 300mg dly Perindopril 8mg dly 2 Telmisartan 80mg dly Enalapril 20mg BD 1 ARB ACEI Patient
  • 9. Results 1 - Membranous GN 2 1 FSGS Partial Remission Complete remission
  • 10. Results- 24 hour Urine Protein 24 hour urine protein: 7.58 + 10.10 to 0.91 + 0.94g/24 hours (p=0.03)
  • 11. Results- Serum Albumin Serum albumin: 18 + 10.49 to 39 + 4.25g/L (p=0.71)
  • 12. Results- Serum Cholesterol Serum cholesterol: 11.38 + 1.72 to 5.15 + 1.07mmol/l (p=0.46)
  • 13. Results- Serum Creatinine Serum Creatinine: 183.75 + 63.93 to 127.50 + 38.20umol/l (p=0.68)
  • 14. Results- eGFR eGFR: 38.76 + 16.25 to 56.52 + 18.81mls/min/1.73m2 (p=0.68)
  • 15. Results- Adverse Events <ul><li>Two patients were hospitalized </li></ul><ul><ul><li>Herpes zoster infection </li></ul></ul><ul><ul><li>(10 days and 5 weeks after MMF initiation). </li></ul></ul>
  • 16. Conclusion <ul><li>MMF could be useful in treatment of FSGS and MN. It appears to be well tolerated. Its efficacy requires validation in randomized, controlled trials. </li></ul>
  • 17. Discussion Clinical Trials on MMF in FSGS
  • 18. CR-1, NR-1 12 1.0-2.0 2 Tasanatong J Ass Med Thai, 06’ CR-5, PR-16, R-7, NR14 43 TOTAL CR-1. NR-1 6-8 1.5 2 Tang, J Nephro 05’ CR-0, PR-8, NR-10 6 2.0 18 Cattran, Clin Neph 04’ CR-1, PR-1 12 2.0 2 Day, NDT 02’ CR-2, PR-6 R-7, NR-2 NA-1 4-24 1.5-2.0 18 Choi, KI 02’ PR 21 2.0 1 Choi, AJKD 98’ Outcome F/up (mths) MMF Dose n
  • 19. Discussion Clinical Trials on MMF in Membranous Nephropathy
  • 20. CR-2, PR-9 R-3, NR-2 , NA-1 4-25 1.5-2.0 17 Choi, KI 02’ CR-3, PR-13, R-9, NR-10 36 TOTAL PR-2, R-6, NR-8 8 0.5-2.0 16 Miller, AJKD 00’ PR-2 CR-1 8-10 1.5-2 3 Choi, AJKD 98 Outcome F/up (mths) MMF Dose (g/day) n
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