Rheumatology Advance Access originally published online on July 27, 2005
Rheumatology 2005 44(10):1317-1321; doi:10.1093/rheumatology/kei019
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Reduction of proteinuria with mycophenolate mofetil in predominantly membranous lupus nephropathy
1 Lupus Research Unit, The Rayne Institute, 2 Immunology Department and 3 Histopathology Department, St Thomas' Hospital, 4 Nephrology Department, Guy's and St Thomas' Hospitals and 5 Kings College London, London, UK.
Correspondence to: M. Y. Karim, Lupus Research Unit, The Rayne Institute, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK. E-mail: yousuf.karim{at}royalsurrey.nhs.uk
Introduction. Lupus membranous nephropathy (LMN) presents a difficult clinical problem as no particular treatment has been proven to be effective. Studies have shown good results with mycophenolate mofetil (MMF) in proliferative lupus nephropathy (LN) (WHO class III and IV disease).
Objectives. To study whether MMF treatment was effective in membranous predominant LN in patients resistant to or intolerant of other immunosuppressive agents.
Patients and methods. We retrospectively studied 10 patients with systemic lupus erythematosus who had biopsy-proven predominant LMN (six Vc patients and four Va or Vb patients). Previous treatments included cyclophosphamide, azathioprine, ciclosporin and corticosteroids. The following parameters were recorded at baseline and follow-up: blood pressure, ECLAM, proteinuria, serum albumin and creatinine, routine haematology and immunology.
Results. The study included eight women and two men, mean age 38.4 ± 7.1 yr (range 30–49 yr). The racial distribution was as follows: five Caucasian, and five Black patients. The mean treatment time with MMF was 18.8 ± 15.4 months (range 3–52 months). Twenty-four-hour urinary protein excretion was reduced from median 2.26 g (range 0–7.92 g) to median 0.66 g (range 0.08–3.85 g) at follow-up (P = 0.0039). Serum albumin increased significantly after treatment from median 29.5 g/l (range 14.0–42.0 g/l) to 33.5 g/l (range 23.0–40.0 g/l) at follow-up (P = 0.04). There were no significant changes in serum creatinine (P = 0.55).
Conclusion. MMF is a potentially useful immunosuppressive agent in reducing the proteinuria associated with membranous predominant LN.
KEY WORDS: Lupus membranous nephropathy, Systemic lupus erythematosus, Mycophenolate mofetil
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