nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1529Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПервый опыт использования мофетила микофенолата в лечении гломерулонефрита у детейFirst experience of using mycophenolate mofetil in treatment of glomerulonephritis in childrenПриходинаЛ. С.PrikhodinaL. S.prikhodina@aport2000.ruДлинВ. В.DlinV. V.noemail@neicon.ruТурпиткоО. Ю.TurpitkoO. Y.noemail@neicon.ruКатышеваО. В.KatyshevaO. V.noemail@neicon.ruЛепаеваТ. В.LepaevaT. V.noemail@neicon.ruАгаповЕ. Г.NikishinaT. A.noemail@neicon.ruНикишинаТ. А.IgnatovaM. S.noemail@neicon.ruИгнатоваМ. С.noemail@neicon.ruФГУ «МНИИ педиатрии и детской хирургии Росздрава», г. МоскваRussian Federation200623062025815559Copyright © Приходина Л.С., Длин В.В., Турпитко О.Ю., Катышева О.В., Лепаева Т.В., Агапов Е.Г., Никишина Т.А., Игнатова М.С., 20252025Приходина Л.С., Длин В.В., Турпитко О.Ю., Катышева О.В., Лепаева Т.В., Агапов Е.Г., Никишина Т.А., Игнатова М.С.Prikhodina L.S., Dlin V.V., Turpitko O.Y., Katysheva O.V., Lepaeva T.V., Nikishina T.A., Ignatova M.S., Игнатова М.С.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1529

Проведено исследование оценки эффективности иммуносупрессанта - мофетила микофенолата (ММФ) у 6 детей с гломерулонефритом. У всех детей отмечен выраженный антипротеинурический эффект, (на 77% от исходного уровня) на фоне 12-месячного курса терапии ММФ. У 1-го пациента с фокально-сегментарным гломерулосклерозом была достигнута частичная клинико-лабораторная ремиссия заболевания, сопровождаемая нормализацией уровня альбумина и креатинина в крови и повышением СКФ. У 2 больных отмечалось транзиторное снижение противовирусного иммунитета на фоне терапии ММФ. Необходимо проведение рандомизированных контролируемых исследований для подтверждения эффективности ММФ в лечении гломерулопатий.

We evaluated an efficacy of mycophenolate mofetil (MMF) in 6 children with glomerulonephritis. The 12 months treatment was effective in reducing of proteinuria in all patients - 77% from baseline level. One child with focal segmental glomerulosclerosis achieved of partial remission of disease with normalized of albumin and creatinine levels in serum and GFR. 2 children had transient of decreasing virus-induced immunity as an adverse effect of treatment with MMF. We need randomized controlled trials in order to confirm of efficacy of MMF in children with glomerulopathies.

мофетила микофенолатиммуносупрессиягломерулонефритнефротический синдромдетиReferencesВознесенская Т.С., Сергеева Т.В. Нефрология и диализ 2003; 5 (1): 45-47.Вознесенская Т.С., Сергеева Т.В. Нефрология и диализ 2003; 5 (1): 45-47.Allison A.C., Eugui E.M. Mycophenolate Mofetil and its mechanisms of action. Immunopharmacology 2000; 47: 85-118.Allison A.C., Eugui E.M. Mycophenolate Mofetil and its mechanisms of action. Immunopharmacology 2000; 47: 85-118.Ardissino G. Epidemiology of chronic renal failure. In: ESPN-handbook. 2002: 369-372.Ardissino G. Epidemiology of chronic renal failure. In: ESPN-handbook. 2002: 369-372.Badid C., Desmouliere A., Laville M. MMF: implication for the treatment of glomerular diseases. Nephrol Dial Transplant 2001; 16: 1752-1756.Badid C., Desmouliere A., Laville M. MMF: implication for the treatment of glomerular diseases. Nephrol Dial Transplant 2001; 16: 1752-1756.Bartosh S.M. The use of mycophenolate mofetil in children with nephrotic syndrome. J Am Soc Nephrol 1999; 10: 95A.Bartosh S.M. The use of mycophenolate mofetil in children with nephrotic syndrome. J Am Soc Nephrol 1999; 10: 95A.Blaneta R.A., Leskel K., Wittig B. et al. Inhibition of endothelial receptor expression and of T-cell ligand activity by mycophenolate mofetil. Transpl Immunol 1998; 6: 251-259.Blaneta R.A., Leskel K., Wittig B. et al. Inhibition of endothelial receptor expression and of T-cell ligand activity by mycophenolate mofetil. Transpl Immunol 1998; 6: 251-259.Briggs W.A., Сhoi M.J., Gimenez L.F., Scheel P.J. Treatment of primary glomerulopathies (1GN) with mycophenolate mofetil (abstract). Abstracts of the ASN 31st Annual Meeting, October 1998, Philadelphia, Pa: Abstract 437.Briggs W.A., Сhoi M.J., Gimenez L.F., Scheel P.J. Treatment of primary glomerulopathies (1GN) with mycophenolate mofetil (abstract). Abstracts of the ASN 31st Annual Meeting, October 1998, Philadelphia, Pa: Abstract 437.Briggs W.A., Сhoi M.J., Scheel P.J. Follow-up on mycophenolate mofetil treatment of glomerular diseases. Am J Kidney Dis 1998; 31: 898-899.Briggs W.A., Сhoi M.J., Scheel P.J. Follow-up on mycophenolate mofetil treatment of glomerular diseases. Am J Kidney Dis 1998; 31: 898-899.Cameron J.S. The enigma of focal segmental glomerulosclerosis. Kidney Int 1996; 50 [Suppl 57]: S119-S131.Cameron J.S. The enigma of focal segmental glomerulosclerosis. Kidney Int 1996; 50 [Suppl 57]: S119-S131.Caropreso M.R., Ferretti A.V., Margieri G. et al. Mycophenolate mofetil in the treatment of children with steroid-dependent nephrotic syndrome. WCN-2003.Caropreso M.R., Ferretti A.V., Margieri G. et al. Mycophenolate mofetil in the treatment of children with steroid-dependent nephrotic syndrome. WCN-2003.Chandra M., Susin M. Remission of relapsing childhood nephrotic syndrome with mycophenolate mofetil. Pediatr Nephrol 2000; 14: 224-226.Chandra M., Susin M. Remission of relapsing childhood nephrotic syndrome with mycophenolate mofetil. Pediatr Nephrol 2000; 14: 224-226.Choi M.J., Eustace J.A., Gimenex L.F., Atta M.G., Scheel P.J., Sothinathan R., Briggs W.A. Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 2002; 61:1098-1114.Choi M.J., Eustace J.A., Gimenex L.F., Atta M.G., Scheel P.J., Sothinathan R., Briggs W.A. Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 2002; 61:1098-1114.Clark A.G., Barratt T.M. Steroid-responsive nephrotic syndrome. In Barratt TM, Avner ED, Harmon WE (eds) Pediatr Nephrology, 4th edn. Lippincott, Williams and Wilkins, Baltimore: 1999: 731-747.Clark A.G., Barratt T.M. Steroid-responsive nephrotic syndrome. In Barratt TM, Avner ED, Harmon WE (eds) Pediatr Nephrology, 4th edn. Lippincott, Williams and Wilkins, Baltimore: 1999: 731-747.Corna D., Morigi M., Facchinetti T. et al. Mycophenolate mofetil limits renal damage and prolongs life in murine lupus autoimmune disease. Kidney Int 1997: 51 (5): 1583-1589.Corna D., Morigi M., Facchinetti T. et al. Mycophenolate mofetil limits renal damage and prolongs life in murine lupus autoimmune disease. Kidney Int 1997: 51 (5): 1583-1589.Dubus I., Vendrely B., Christophe I. et al. Mycophenolic acid antagonizes the activation of cultured human mesangial cells. Kidney Int 2002: 62 (3): 857-867.Dubus I., Vendrely B., Christophe I. et al. Mycophenolic acid antagonizes the activation of cultured human mesangial cells. Kidney Int 2002: 62 (3): 857-867.Eugui E.M., Amquist S.J., Muller C.D., Allison A.C. Lymphocytoselective citostatic and immunosuppressive effects of mycophenolic acid in vitro: role of deoxyguanosine nucleotide depletion. Scand J Immunol 1991; 33: 161-173.Eugui E.M., Amquist S.J., Muller C.D., Allison A.C. Lymphocytoselective citostatic and immunosuppressive effects of mycophenolic acid in vitro: role of deoxyguanosine nucleotide depletion. Scand J Immunol 1991; 33: 161-173.Eugui E.M., Mircovich A., Allison A.C. Lymphocyte-selective antiproliferative and immunosuppressive effects of mycophenolic acid in mice. Scand J Immunol 1991; 33: 175.Eugui E.M., Mircovich A., Allison A.C. Lymphocyte-selective antiproliferative and immunosuppressive effects of mycophenolic acid in mice. Scand J Immunol 1991; 33: 175.Fujihara C.K., Avancini Costa Malheiros D.M., de Lourdes Noronha I. et al. Mycophenolate mofetil reduces renal injury in the chronic nitric oxide synthase inhibition model. Hypertension 2001; 37 (1): 170-175.Fujihara C.K., Avancini Costa Malheiros D.M., de Lourdes Noronha I. et al. Mycophenolate mofetil reduces renal injury in the chronic nitric oxide synthase inhibition model. Hypertension 2001; 37 (1): 170-175.Fujihara C.K., De L.N., Malheiros I. et al. Combined mycophenolate mofetil and losartan therapy arrests established injury in the remnant kidney. О Am Soc Nephrol 2000; 11: 283-290.Fujihara C.K., De L.N., Malheiros I. et al. Combined mycophenolate mofetil and losartan therapy arrests established injury in the remnant kidney. О Am Soc Nephrol 2000; 11: 283-290.Gellerman J., Querfeld U. Frequently relapsing nephrotic syndrome: treatment with mycophenolate mofetil. Pediatr Nephrol 2004; 19: 101-104.Gellerman J., Querfeld U. Frequently relapsing nephrotic syndrome: treatment with mycophenolate mofetil. Pediatr Nephrol 2004; 19: 101-104.Hauser I.A., Renders L., Radeke H.H. еt al. Mycophenolate Mofetil inhibits rat and human mesangial cell proliferation by guanosine depletion. Nephrol Dial Transplant 1999; 14: 58-63.Hauser I.A., Renders L., Radeke H.H. еt al. Mycophenolate Mofetil inhibits rat and human mesangial cell proliferation by guanosine depletion. Nephrol Dial Transplant 1999; 14: 58-63.Hogg R., Fitzibbons L., Bruik J., Bunke M., Ault B., Baqi N., Trachtman H., Swinford R. Multicenter trial of mycophenolate mofetil (MMF) in children with steroid dependent (SD) or frequent relapsing (FR) nephrotic syndrome (NS). Report of the South West Pediatric Nephrology Study Group. Nephrol Dial Transplant 2003; 18: 261.Hogg R., Fitzibbons L., Bruik J., Bunke M., Ault B., Baqi N., Trachtman H., Swinford R. Multicenter trial of mycophenolate mofetil (MMF) in children with steroid dependent (SD) or frequent relapsing (FR) nephrotic syndrome (NS). Report of the South West Pediatric Nephrology Study Group. Nephrol Dial Transplant 2003; 18: 261.International Study of Kidney Disease in Children. The primary nephrotic syndrome in children Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. О Pediatr 1981: 98; 561-564.International Study of Kidney Disease in Children. The primary nephrotic syndrome in children Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. О Pediatr 1981: 98; 561-564.Jonsson C.A., Svensson L., Carlsten H. Beneficial effect of the inosine monophosphate dehydrogenase inhibitor mycophenolate mofetil on survival and severity of glomerulonephritis in systemic lupus erythematosus (SLE)-prone MRLlpr/mice. Clin Exp Immunol 1999; 116: 534-541.Jonsson C.A., Svensson L., Carlsten H. Beneficial effect of the inosine monophosphate dehydrogenase inhibitor mycophenolate mofetil on survival and severity of glomerulonephritis in systemic lupus erythematosus (SLE)-prone MRLlpr/mice. Clin Exp Immunol 1999; 116: 534-541.Korbet S.M., Genchi R., Borok R.Z., Schwartz M.M. The racial prevalence of glomerular lesions in nephritic adults. Am J Kidney Dis 1996; 27: 647-651.Korbet S.M., Genchi R., Borok R.Z., Schwartz M.M. The racial prevalence of glomerular lesions in nephritic adults. Am J Kidney Dis 1996; 27: 647-651.Lee W.A., Gu L., Miksztal A.R., Chu N., Leung K., Nelson P.H. Bioavailability improvement of mycophenolic acid through amino ester derivatisation. Pharm Res 1990; 7: 161.Lee W.A., Gu L., Miksztal A.R., Chu N., Leung K., Nelson P.H. Bioavailability improvement of mycophenolic acid through amino ester derivatisation. Pharm Res 1990; 7: 161.Montane B., Abitbol C., Paredes A., Zilleruelo G., Strauss J. Mycophenolate mofetil (MMF) treatment in steroid resistant /relapsing nephrotic syndrome (NS) of childhood. J Am Soc Nephrol 1999; 10: 111A.Montane B., Abitbol C., Paredes A., Zilleruelo G., Strauss J. Mycophenolate mofetil (MMF) treatment in steroid resistant /relapsing nephrotic syndrome (NS) of childhood. J Am Soc Nephrol 1999; 10: 111A.Morris R.E., Hoyt E.G., Murphy M.P. et al. Mycophenolic acid morpholinoethylester (RS-61443) is a new immunosuppressant that prevents and halts heart allograft rejection by selective inhibition of T- and B-cell purine synthesis. Transplant I Proc 1990; 22: 1659-1662.Morris R.E., Hoyt E.G., Murphy M.P. et al. Mycophenolic acid morpholinoethylester (RS-61443) is a new immunosuppressant that prevents and halts heart allograft rejection by selective inhibition of T- and B-cell purine synthesis. Transplant I Proc 1990; 22: 1659-1662.Morris R.E., Wang J. Comparison of the immunosuppressive effects of mycophenolic acid and the morpholinoethylester of mycophenolic acid (RS-61443) in recipients of heart allografts. Transplant I Proc 1991; 23: 493-496.Morris R.E., Wang J. Comparison of the immunosuppressive effects of mycophenolic acid and the morpholinoethylester of mycophenolic acid (RS-61443) in recipients of heart allografts. Transplant I Proc 1991; 23: 493-496.Morris R.E., Wang J., Blum J.K. et al. Immunosuppressive effects in rat and nonhuman primate recipients of heart allografts. Transplant I Proc 1991; 23 (suppl): 19.Morris R.E., Wang J., Blum J.K. et al. Immunosuppressive effects in rat and nonhuman primate recipients of heart allografts. Transplant I Proc 1991; 23 (suppl): 19.Penny M.J., Boyad R.A., Hall B.M. Mycophenolate Mofetil prevents the induction of active Heymann nephritis: association with Th2 cytokine inhibition. J Am Soc Nephrol 1998; 9: 2272-2282.Penny M.J., Boyad R.A., Hall B.M. Mycophenolate Mofetil prevents the induction of active Heymann nephritis: association with Th2 cytokine inhibition. J Am Soc Nephrol 1998; 9: 2272-2282.Rothenberg M.B., Heymann W. The incidence of the nephrotic syndrome in children. Pediatrics 1957; 19: 446-452.Rothenberg M.B., Heymann W. The incidence of the nephrotic syndrome in children. Pediatrics 1957; 19: 446-452.Schlesinger E.R., Sultz H.A., Mosher W.E. Feldman JG. The nephrotic syndrome: Its incidence and implications for the community. Am J Dis Child 1968; 116: 623-632.Schlesinger E.R., Sultz H.A., Mosher W.E. Feldman JG. The nephrotic syndrome: Its incidence and implications for the community. Am J Dis Child 1968; 116: 623-632.Senda M., DeLustro B., Eugui E., Natsumeda Y. Mycophenolic acid, an inhibitor of IMP dehydrogenase that is also on immunosuppressive agent, suppresses the cytokine-induced nitric oxide production in mouse and rat vascular endothelial cells. Transplantation 1995; 60: 1143-1148.Senda M., DeLustro B., Eugui E., Natsumeda Y. Mycophenolic acid, an inhibitor of IMP dehydrogenase that is also on immunosuppressive agent, suppresses the cytokine-induced nitric oxide production in mouse and rat vascular endothelial cells. Transplantation 1995; 60: 1143-1148.Strivastava T., Simon S.D., Alon U.S. High incidence of focal segmental glomerulosclerosis in nephrotic syndrome of childhood. Pediatr Nephrol 1999; 13: 13-18.Strivastava T., Simon S.D., Alon U.S. High incidence of focal segmental glomerulosclerosis in nephrotic syndrome of childhood. Pediatr Nephrol 1999; 13: 13-18.Sugomoto H., Shikata K., Wada J. et al. Advanced glycation and products-cytokine-nitric oxide sequence pathway in the development of diabetic nephropathy: Aminoguanidine ameliorates the overexpression of tumor-necrosis factor-alpha and inducible nitric oxide synthase in diabetic rat glomeruli. Diabetologia 1999; 42: 878-892.Sugomoto H., Shikata K., Wada J. et al. Advanced glycation and products-cytokine-nitric oxide sequence pathway in the development of diabetic nephropathy: Aminoguanidine ameliorates the overexpression of tumor-necrosis factor-alpha and inducible nitric oxide synthase in diabetic rat glomeruli. Diabetologia 1999; 42: 878-892.Ziswiler R., Steinmann-Niggli K., Kappeler A., Daniel C., Marti H.P. Mycophenolic acid: a new approach to the therapy of experimental mesangial proliferative glomerulonephritis. J Am Soc Nephrol 1998; 9: 2055-2066.Ziswiler R., Steinmann-Niggli K., Kappeler A., Daniel C., Marti H.P. Mycophenolic acid: a new approach to the therapy of experimental mesangial proliferative glomerulonephritis. J Am Soc Nephrol 1998; 9: 2055-2066.

The authors declare that there are no conflicts of interest present.