The accumulated experience with the use of mycophenolate mofetil in primary glomerulonephritis

Abstract

Importance of the field: The use of mycophenolate mofetil (MMF) has been extended from renal transplantation to the treatment of glomerulonephritis. MMF has been used in patients with steroid- and ciclosporin A (CsA)-dependent or -resistant idiopathic nephrotic syndrome and in patients with deteriorating renal function or adverse reactions to other drugs. MMF has been also used in patients with membranous and IgA nephropathy after failure of other regimens as well as initial treatment.

Areas covered in this review: The rationale of MMF treatment in primary glomerulonephritis is based in its antifibrotic and antiproteinuric effects. The mechanism of action is described; the results of cohort and randomized trials in minimal change disease, focal segmental glomerulosclerosis, idiopathic membranous nephropathy and IgA nephropathy are presented along with the adverse reactions profile and the expert opinion.

What the reader will gain: This is an up-to-date review providing insight on this novel agent that is increasingly used in the therapeutics of primary glomerulonephritis.

Take home message: Although the results are conflicting, MMF seems to be effective at least in some patients, who do not respond to corticosteroids, ciclosporin or cytotoxic drugs. However, the experience with MMF in primary glomerulonephritis is limited and further research is required in order to establish MMF in the treatment of patients with glomerular disease.

Keywords::

• focal segmental glomerulosclerosis
• glomerulonephritis
• IgA nephropathy
• membranous nephropathy
• minimal change disease
• mycophenolate mofetil
• nephrotic syndrome