No abstract available.
Drug Monitoring ; Mycophenolic Acid

To investigate the effects of mycophenolate mofetil (MMF) on the process of renal interstitial fibrosis, unilateral ureteral obstruction (UUO) model was established in rats. Twenty Sprague-Dawley rats underwent UUO and received vehicle (n = 10) or MMF (20 mg.kg-1.d-1, by daily gastric gavage, n = 10) during a period of 5 days following surgery, and the additional 10 rats were served as sham-operated group. The rats were killed 5 days after surgery. Immunohistochemistry was performed on renal tissue for proliferating cell nuclear antigen (PCNA), alpha-smooth muscle actin (alpha-SMA) and type I and III collagen (col I, col III). Histological studies were also done by MASSON staining. Five days after surgery, proliferating cells in tubules, interstitium as well as interstitial myofibroblast (MyoF) infiltration and interstitial col I, col III deposition were all significantly reduced by MMF treatment. MMF also alleviated the histological changes of UUO rats. These results suggested that the reduction of interstitial MyoF infiltration may be an important event by which MMF prevents renal injury caused by UUO and MMF could be used to limit the progression of renal fibrosis.
Fibrosis ; Kidney/*pathology ; Kidney Diseases/etiology ; Kidney Diseases/pathology ; Kidney Diseases/*prevention & control ; Mycophenolic Acid/*analogs & derivatives ; Mycophenolic Acid/*pharmacology ; Random Allocation ; Rats, Sprague-Dawley ; Ureteral Obstruction/*complications

BACKGROUND/AIMS: Our study aimed to evaluate the efficacy of MMF as compared with intravenous cyclophosphamide as induction therapy for proliferative lupus nephritis in Koreans. METHODS: Forty-three patients who were diagnosed with proliferative lupus nephritis (WHO Class III and IV) between Jan 2000 and Dec 2006 were included in this study. Nineteen patients were treated with oral MMF (initial dose: 1.0 g/day and then it was increased to 2.0 g/day) and 24 patients were treated with 0.75-1.0 g/m2 of monthly intravenous cyclophosphamide (CP) followed by subsequent treatment with oral corticosteroid (initial dose 1 mg/kg/day and then it was slowly tapered down) for 6 months. The demographic and laboratory findings, the response rate and the adverse events were reviewed retrospectively and these were compared between the two groups. RESULTS: A complete response occurred in 7 out of the 19 patients (36.8%) treated with MMF and in 8 out of the 24 patients (33.3%) treated with CP, and the difference was not significantly different between the two groups (p=0.66). A partial response was achieved in 52.6% and 45.8%, respectively. There were no significant differences of the laboratory findings such as serum albumin, C3, C4, the urine protein/creatinine ratio and serum creatinine after treatment for 6 months. In addition, both groups had similar rates of adverse events. CONCLUSIONS: Our study showed that for the treatment of lupus nephritis, MMF was as effective as IV cyclophosphamide with similar adverse events. This finding suggests that MMF could be an alternative treatment for active lupus nephritis as induction therapy.
Creatinine ; Cyclophosphamide ; Humans ; Lupus Nephritis ; Mycophenolic Acid ; Retrospective Studies ; Serum Albumin

Much progress has been made in the elucidation of potential pathogenetic mechanisms of glomerulonephritis such as anti-PLA2R autoantibody in membranous nephropathy and under-galactosylated IgA1 in IgA nephropathy as well as in the fields of treatment. This knowledge is, hopefully in the future, being applied in the development of the creation of rational therapeutic approaches. Current treatment strategies for glomerular diseases recommended by many clinical studies include high-dose glucocorticoids, calcineurin inhibitors, cyclophosphamide, mycophenolate mofetil, and rituximab. Although these therapies have been effective in treating immune-mediated glomerular diseases, they all have potentially serious side effects.
Antibodies, Monoclonal, Murine-Derived ; Calcineurin ; Cyclophosphamide ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glucocorticoids ; Immunoglobulin A ; Mycophenolic Acid ; Rituximab

Mycophenolate mofetil (MMF) is being widely used as a maintenance imunosuppressive therapy in renal transplant patients. Myelotoxicity and gastrointestinal symptoms are the well-known adverse effects of this immunosuppressant. However, there areexistonly two reports on oral ulceration associtated with MMF. Although oral ulcerations are not life-threatening, they may seriously affect the quality of life. We report ourthe experience of a case of a 57-year-old female patient with painful oral mucosal ulcerations that improved following MMF discontinuation.
Female ; Humans ; Kidney Transplantation ; Middle Aged ; Mycophenolic Acid ; Oral Ulcer ; Quality of Life ; Transplants ; Ulcer

PURPOSE: Although cyclosporine (CsA) improves short-term renal graft outcomes, many paradigms reduce or withdraw this drug because of its nephrotoxicity. However, inadequate immunosuppression with azathioprine led to little success. We conducted a prospective study to define the prolonged effect of CsA reduction in stable renal transplant recipients with mycophenolate mofetil (MMF). METHODS: Thirty-nine primary renal transplant recipients were divided into two cohorts, the AZA (N=13) and the MMF cohort (N=26). Both cohorts were allowed to reduce the CsA dose up to 50% of baseline within 3 to 4 months of conversion to AZA or MMF. Graft function, clinical parameters, and adverse events were monitored for up to 3 years. RESULTS: Ccr gradually deteriorated in the AZA cohort, but was stable in the MMF cohort. There was no episode of acute rejection or graft loss observed in either cohort. CONCLUSION: The CsA dose can be reduced in combination with MMF treatment in stable renal transplant recipients after 2 years of transplantation, resulting in beneficial effects on Ccr, lipid profiles, and blood pressure.
Azathioprine ; Cohort Studies ; Cyclosporine ; Immunosuppression ; Kidney Transplantation ; Mycophenolic Acid ; Prospective Studies ; Rejection (Psychology) ; Transplants

Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.
Antiviral Agents ; Colic ; Cytomegalovirus ; Diarrhea ; Ganciclovir ; Kidney ; Kidney Transplantation ; Mycophenolic Acid ; Risk Factors ; Transplants ; Viral Load

PURPOSE: Mycophenolate mofetil (MMF) is thought to have not only low frequency of adverse side effects but also have equal efficacy to other conventional immunosuppressants (CIS). But It's hard to conclude that CIS may be replaceable with MMF. So we inquired into another aspect of MMF as 'Rescue therapy' in non-transplant renal diseases. METHODS: Twenty nine patients with non-transplant renal diseases received MMF therapy between January 2000 and April 2007. Eighteen patients who had received MMF more than 6 months were included. Sixteen of the 18 patients included were resistant to CIS and two were patients who maintained complete remission (CR) with MMF because of the adverse side effects of CIS. Treatment outcome was evaluated by dip-stick urine test. CR was defined by negative or trace, partial remission (PR) by 1 positive and treatment failure (TF) by more than 1 positive. RESULTS: Eleven of the resistant 16 patients had shown CR (69%) and maintained CR. Two of maintenance therapy with MMF had kept CR more than 12 months. The proportions of the patients who had shown decreased proteinuria in each treatment duration were 69% for 3 months (p=0.005), 81% for 6 months (p=0.001), 86% for 9 months (p=0.002) and 91% for 12 months (p=0.004), respectively. There were few adverse effects. CONCLUSION: We observed the efficacy of MMF in decreasing proteinuria and maintaining CR as 'Rescue therapy' for previously treated non-transplant renal disease patients with CIS. Large controlled clinical trials are expected for defining this effect.
Humans ; Immunosuppressive Agents ; Kidney Diseases ; Mycophenolic Acid ; Proteinuria ; Treatment Failure ; Treatment Outcome

OBJECTIVES: To investigate the perception of and treatment pattern with regard to the four important issues in the management of lupus nephritis (LN), and to identify which parts of the LN treatment are difficult for physicians to carry out in clinical practice. METHODS: Four steps were carried out: pre-survey, LN symposium, post-survey, and meeting after the symposium.The two surveys were conducted with the same contents regarding renal biopsy, induction and maintenance treatment for class III and IV LN, and treatment for class V LN. The results of the first survey and the changes in opinion reflected in the second survey were comparatively analyzed. RESULTS: In the first survey, most of the respondent physicians replied that they would immediately conduct biopsy in the case of significant proteinuria. For the induction treatment of class III and IV LN, most of the respondent physicians selected high-dose cyclophosphamide. Mycophenolate mofetil and steroid combination therapy were selected for the maintenance treatment, and tacrolimus for the treatment of class V LN. There was a controversy in the drug selection, however, especially on the maintenance treatment of class III and IV LN and on the treatment of non-responsive class V LN. CONCLUSION: Some discrepancies were found in the treatment of LN in the real world. Although no recommendation was made for Korean LN patients in this study, the study results will help physicians select the most reasonable treatment for Korean LN patients based on experts' experiences and objective evidence.
Biopsy ; Cyclophosphamide ; Surveys and Questionnaires ; Humans ; Lupus Nephritis ; Mycophenolic Acid ; Proteinuria ; Tacrolimus

OBJECTIVES: This study was aimed to examine whether participants of a Korean candlelight rally had correct medical information about human mad cow disease and rational attitudes about imported U.S. beef in relation to human mad cow disease. METHODS: A total of 393 face-to-face interviews were conducted, and subjects completed questions about prevalence of senile dementia and human mad cow disease in U.S. and whether they will eat U.S. beef even if no cases of human mad cow disease occurred in the U.S. or if the chance of being affected with human mad cow disease was lower than dying in a plane crash. RESULTS: Correct answer rates to the questions about prevalence of senile dementia and human mad cow disease were 28.2% and 36.1%, respectively. A majority of respondents answered that they would not eat U.S. beef even if there were no reported cases of human mad cow disease in the U.S. or if their chance of being affected with human mad cow disease was lower than dying in a plane crash (75.6% and 86.0%, respectively). CONCLUSION: At least 64.4% of participants had incorrect medical information about human mad cow disease, and their attitudes about imported U.S. beef may be rooted in emotion rather than fact.
Adenine Nucleotides ; Alzheimer Disease ; Animals ; Cattle ; Surveys and Questionnaires ; Encephalopathy, Bovine Spongiform ; Humans ; Korea ; Mycophenolic Acid ; Prevalence