Remission of resistant MPGN type I with mycophenolate mofetil and steroids |
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Authors: | Sudarsana De Dana Al-Nabhani Paul Thorner Daniel Cattran Tino D Piscione Christoph Licht |
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Institution: | (1) Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada;(2) Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada;(3) Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada;(4) University of Toronto, Toronto, ON, Canada;(5) Division of Nephrology, Toronto General Hospital, Toronto, ON, Canada |
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Abstract: | Very few studies have been published on how to treat children with membranoproliferative glomerulonephritis type I (MPGN I),
and as yet there is only one report on the use of mycophenolate mofetil (MMF) in children with MPGN I. We report a 12-year-old
boy who presented with edema, hypertension, nephrotic range proteinuria, and microscopic hematuria following an upper respiratory
tract infection. Laboratory tests revealed a serum creatinine of 90 μmol/l, albumin of 20 g/l, and a C3 of 0.11 g/l (normal
range: 0.7–1.4). Renal biopsy showed the presence of MPGN I. Upon failure to induce remission with prednisone, we started
the patient on MMF at 500 mg/day (300 mg/m2), increasing up to a final dose of 2 g/day (1200 mg/m2), with a MMF metabolite mycophenolic acid (MPA) target range of 2–5 mg/l. Prednisone was subsequently reduced to alternate
day therapy and gradually weaned to 7.5 mg on alternate days over 9 months. Within 4 months of starting MMF therapy, there
was significant improvement in serum creatinine (decrease from 156 to 64 μmol/l), serum albumin (increase from 23 to 40 g/l),
and proteinuria (decrease from 13 g/day to 40 mg/day). Twelve months following the introduction of MMF into his therapeutic
regimen, he remains in remission with no further relapses. In summary, this case suggests that there may be potential benefit
for use of MMF in children with refractory MPGN I, which supports the rationale for prospectively evaluating MMF treatment
in a treatment trial of refractory MPGN I. |
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Keywords: | Membranoproliferative glomerulonephritis type I Mycophenolate mofetil Prednisone Proteinuria |
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