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Novel therapy of focal glomerulosclerosis with mycophenolate and angiotensin blockade

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Abstract

Steroid-resistant nephrotic syndrome of childhood poses a dilemma in attempting to balance toxicity of medications against long-term prognosis. This report presents our preliminary experience with the novel use of combined mycophenolate mofetil (MMF) and angiotensin blockade (AB) in the treatment of nine children and young adults with focal glomerulosclerosis (FSGS). All patients were steroid resistant and had failed conventional treatment regimens. Prior to the initiation of the MMF-AB protocol, the patients were pre-treated with weekly intravenous methylprednisolone (MP) (15 mg/kg per week) for 4–8 weeks. Angiotensin-converting-enzyme inhibitors and/or angiotensin receptor blockers were begun when intravascular volume was restored. MMF was given at a dose of 250–500 mg/m2 per day. Proteinuria, as measured by urine protein/creatinine ratios (Up/c), decreased by 43% following MP (P<0.05). After 6 months of MMF-AB protocol, the Up/c was 72% below baseline (P<0.01). This level was maintained for a minimum of 24 months of observation. Similarly, hyperlipidemia, as measured by total cholesterol and triglycerides, improved significantly with treatment (536±163 to 265±70 mg/dl, 447±168 to 230±92 mg/dl, respectively, P<0.01). Our data support the use of MMF and AB for treatment of steroid-resistant FSGS when other conventional treatments have failed and/or induced toxicity.

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Acknowledgements

This work was supported in part by a grant from the State of Florida Department of Health, Children's Medical Services.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, University of Miami/ Jackson Children's Hospital, P.O. Box 016960 (M-714), Miami, Florida 33101, USA

    Brenda Montané, Carolyn Abitbol, Jayanthi Chandar, José Strauss & Gastón Zilleruelo

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  1. Brenda Montané
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  2. Carolyn Abitbol
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  3. Jayanthi Chandar
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  4. José Strauss
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  5. Gastón Zilleruelo
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Correspondence to Brenda Montané.

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Montané, B., Abitbol, C., Chandar, J. et al. Novel therapy of focal glomerulosclerosis with mycophenolate and angiotensin blockade. Pediatr Nephrol 18, 772–777 (2003). https://doi.org/10.1007/s00467-003-1174-5

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  • DOI: https://doi.org/10.1007/s00467-003-1174-5

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