Universität zu Köln

Hackl, Agnes, Becker, Jan U., Koerner, Lisa M., Ehren, Rasmus, Habbig, Sandra, Nuesken, Eva, Nuesken, Kai-Dietrich, Ebner, Kathrin, Liebau, Max C., Mueller, Carsten, Pohl, Martin and Weber, Lutz T. (2018). Mycophenolate mofetil following glucocorticoid treatment in Henoch-Schonlein purpura nephritis: the role of early initiation and therapeutic drug monitoring. Pediatr. Nephrol., 33 (4). S. 619 - 630. NEW YORK: SPRINGER. ISSN 1432-198X

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Abstract

Background Henoch-Schonlein purpura (HSP) is the most common vasculitis in childhood and traditionally considered as a self-limiting disease. However, renal involvement can unfavorably determine long-term prognosis. The reported regimens to treat HSP nephritis (HSPN) are diverse, indicating that the most effective treatment remains controversial. Methods This retrospective, single-center study involved 18 patients presenting with HSPN and nephrotic-range proteinuria. We aimed to investigate the efficacy and safety of mycophenolate mofetil (MMF) and identify a cut-off level for estimated mycophenolic acid area under the curve (eMPA-AUC(0-12h)) values, which can predict complete remission with high sensitivity. Results Despite prior insufficient therapeutic response to corticosteroids, 89% of patients showed a significant decrease in proteinuria after 1 month of MMF treatment. None of them relapsed during treatment; however, two children relapsed after discontinuation. Based on results of a receiver operating characteristic (ROC) analysis, an eMPA-AUC(0-12h) >56.4 mg*h/l was a predictor for complete remission within 3 months (80% sensitivity, 83.3% specificity, p = 0.035). During MMF administration, we encountered no adverse event requiring discontinuation of treatment. Conclusion Our study demonstrates that MMF is a safe and potentially effective secondary treatment option for children with HSPN to achieve and maintain long-term remission without serious side effects. To achieve complete remission within 3 months, resolve severe inflammatory glomerular lesions, and avoid progression to chronic kidney disease, we propose timely diagnosis and early initiation of MMF with an eMPA-AUC0-12h value of 56.4 mg*h/l.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hackl, Agnes UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Jan U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerner, Lisa M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ehren, Rasmus UNSPECIFIED UNSPECIFIED UNSPECIFIED Habbig, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Nuesken, Eva UNSPECIFIED UNSPECIFIED UNSPECIFIED Nuesken, Kai-Dietrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Ebner, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebau, Max C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Pohl, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Lutz T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-190197
DOI:	10.1007/s00467-017-3846-6
Journal or Publication Title:	Pediatr. Nephrol.
Volume:	33
Number:	4
Page Range:	S. 619 - 630
Date:	2018
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-198X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PHARMACOKINETIC-PHARMACODYNAMIC RELATIONSHIP; IDIOPATHIC NEPHROTIC SYNDROME; RENAL-TRANSPLANT RECIPIENTS; ORAL IMMUNOSUPPRESSANTS; IGA NEPHROPATHY; MESANGIAL CELLS; CHILDREN; ACID; DISEASE; GLOMERULONEPHRITIS Multiple languages Pediatrics; Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19019