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Mycophenolate mofetil (MMF) therapeutic approach in patients with chronic glomerulonephritis (GN).

To the Editor: In a recent issue of Kidney International, Dr. Levin [1] presented successful treatment of patients with membranoproliferative glomerulonephritis (GN) using mycophenolate mofetil (MMF). We obtained contradictory results using MMF in five patients with resistant nephrotic syndrome (NS) during primary GN. MMF (1 g two times daily) was administered to patients as a second approach medication (Table 1). Before MMF therapy, patients were treated with corticosteroids and cyclophosphamide or cyclosporin. Along with MMF, the patients received hypolipemic treatment, angiotensin-converting enzyme (ACE) inhibitors, and small doses of corticosteroids. In the patients, creatinine clearance was normal and stable over a period of several years before introduction of MMF. Positive response was observed in one patient, while in the other four, even an increase in proteinuria was observed, despite prolongation of the treatment up to 18 months. In the patient with diagnosis of focal segmental glomerulosclerosis (FSGS), a marked rise in proteinuria and a decrease in creatinine clearance was observed, with aggravation of renal insufficiency requiring dialysis a year and a half after discontinuation of therapy. The only MMFsensitive patient in our study was a female with a 13-year history of renal disease who continued to be in remission one year after the MMF treatment was concluded. Results of our study are, therefore, substantially different from earlier reports [2, 3]. The coexisting major lipid and protein disorders, along with low gammaglobulin concentrations, were likely to contribute to increased risk of infections, which resulted in an increase of proteinuria and resistance to treatment. In light of the above, the