Study of mycophenolate therapy in treatment of childhood nephrotic syndrome / Amr Mohamed Mustafa Ramadan ; Supervised Mohamed Hesham Safouh , Rasha Essam Eldin Galal , Doaa Mohamed Salah

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Corticosteroids represent the main line of treatment of childhood nephrotic syndrome. However, many cases are either resistant to treatment or experience major side effects to treatment. Mycophenolate mofetil (MMF) can be used in children with glomerulopathy secondary to immunological disorders such as FRNS/SDNS or SRNS. The aim of this study is to evaluate efficacy and safety of MMF in treatment of childhood nephrotic syndrome. Methodology: Thirty children (21 males and 9 females) with NS (13 cases with FRNS/SDNS and 17 cases with SRNS) who received MMF were included. Included cases were subjected to history taking, clinical assessment and review of their medical records. Results: The median age of diagnosis was 3.9 years. 11 cases (91.7%) out of 13 FR/SDNS cases showed no relapse after 6 months of MMF therapy. 7 cases (43.8%) out of 17 SRNS cases achieved complete remission and 3 cases (18.8%) of them achieved partial remission after 6 months of MMF therapy. MMF was able to reduce steroid dose from 12.5±7 mg/day to 5.5±10mg /day after 6 months of its administration. MMF significantly induced remission and decreased frequency of relapses in NS cases who were on CNI only (p=0.002). MMF is well tolerated in our cases with the most frequent side effects was GIT upset (26.7%) then infection (23.3%). Conclusion: Mycophenolate therapy significantly prolongs remission period and allows steroid withdrawal in FRNS/SDNS. MMF is efficiently useful in induction of remission and reduction of relapse frequency when added to CNI in resistant cases of NS. MMF is tolerable and relatively safe immunosuppressive therapy in children with NS

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