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PRİMER MEMBRANOPROLİFERATİF GLOMERULONEFRİT TEDAVİSİNDE MİKOFENOLAT MOFETİL KULLANIMI: RETROSPEKTİF DEĞERLENDİRME

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2002

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Mycophenolate mofetil treatment of primary membranoproliferative glomevulonephritis: ret-rospective analysis. Primary membranoproliferative glomerulonephritis (MPGN) is a progres¬sive disease of which permanent remission rate is very low. In adult patients, its treatment consists of mainly Standard steroid drugs alone or combined with cytostatic drugs or other im-munosuppressive drugs like Cyclosporine-A. Mycophenolate Mofetil(MMF) is a new potenti-al drug in the treatment of primary glomerulonephritis. In our study 6 patients suffering from MPGN (3 vvomen, 3 men) that used MMF were analysed retrospectively; mean age was 31.6(18-50) years, the time of disease before MMF treatment was 17.8(2-70) months. Mycophenolate Mofetil dosages were lg (twice a day) in 4 patients, 0.75g(twice a day) in one patient and 0.5g (tvvice a day) in one patient in whom diabetes mellitus developed under steroid treatment. Mean MMF treatment duration was 8.08(6.5-10) months. Complete remission was achi-ved in 5 patients (the earliest at the first month, the latest in the 9.th month of MMF treatment). In one patient who is at the 6.th month of MMF treatment partial remission was provi-ded. This successfull rate of treatment may be attributed to the inhibitory effects of MMF on lymphocytes but also to antiproliferative efffects of MMF on glomerular mesangial cells and myofibroblasts. Beginning of the improvement in proteinuria, serum albumin and cholesterol levels were seen in the first month of the treatment an continued in the follovving months. No significant changes in serum creatinine levels were seen in the treatment time and no adverse effects of MMF was recorded. As a result, according to present study, MMF therapy alone or together with steroids to patients with MPGN vvhose renal functions are normal, seems to be beneficial.
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Abstract (Original Language): 
Primer membranoproliferatif glomerulonefrit (MPGN) progressif seyirli ve kalıcı remisyon oranı düşük olan bir glomerulonefrittir, erişkinlerde konservatif tedaviye ek olarak standart steroid tedavisi ve birlikte sitotoksik veya siklosporin-A (CsA) gibi diğer immunosupressifler verilebilir. Bu tedavi uygulamalarına rağmen prognozu üzerinde belirgin iyileşmeler sağlanamamıştır. Mikofenolat mofetil (MMF); idiopatik glomeruler hastalıkların tedavisinde potansiyel yeni bir ilaçtır. Bu çalışmada MMF kullanılmış primer MPGN'li hastalarımız retrospektif olarak değerlendirilmiştir. Çalışmaya 3'ü erkek, 3'ü kadın olmak üzere toplam 6 hasta alınmıştır. Hastaların yaş ortalamaları 31.6(18-50) olup, MMF başlanmadan önceki MPGN tanı süresi ortalama 17.8 (2-70)ay idi. Hastaların dördüne 2xlg MMF başlanırken bir hastaya 2x0.75g/gün, diyabet gelişen bir hastaya ise 2x0.5g/giin dozunda MMF başlandı. Ortalama 8.08 (6.5-10) ay MMF tedavisi verilen hastalardan 5'inde (en erken 1., en geç 9. ayda, ortalama 5. ayda olmak üzere) tam remisyon saptanırken MMF tedavisinin 6.5 ayında olan bir hastada parsiyel remisyon sağlanmıştır. Hastaların MMF'ye bu kadar müspet yanıt vermesindeki ana mekanizmanın MMF'nin lenfositler üzerindeki immunosupressif etkileri yanında mezangi-yal hücre proliferasyonunu ve miyofibroblasta diferansiyasyonunu inhibe edici etkinliğin de önemli rolü olabileceği düşünülmüştür. Tedavi sırasında proteinüri, hiperlipidemi, albumin düzeyi gibi parametrelerde anlamlı düzelmelerin 1. aydan itibaren başlamakta olduğu ve anlamlı düzelmenin tedavi süresince devam ettiği gözlendi. Hastaların serum kreatinin düzeylerinde çalışma süresince önemli farklılık görülmedi ve MMF'ye bağlı oluşabildiği bildirilen gastroin-testinal ve miyelosupressif yan etkiler gözlenmedi. Sonuç olarak böbrek fonksiyonları normal olan MPGN'li hastaların tedavisinde düşük doz steroid ile birlikte ya da yalnız başına MMF verilmesi, bu retrospektif çalışmaya göre cesaret verici görünmektedir.
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  • 2
129-136
  • Turkish

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