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《CHINESE JOURNAL OF NEPHROLOGY, DIALYSIS & TRANSPLANTATION》 1998-06
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MYCOPHENOLATE MOFETIL(MMF)TREATMENT FOR REFRACTORY SEVERE LUPUS NEPHRITIS

Hu Weixin,Liu Zhihong,Chen Huiping,Tang Zheng,Li Leishi Research Institute of Nephrology,Jinling Hospital,Nanjing University School of Medicine.Nanjing 210002  
OBJECTIVE Mycophenolate mofetil(MMF),a new immunosuppressive drug which selectively inhibits T and B lymphocytes proliferation,was reported to treat lupus nephritis(LN)in several uncontrolled studies of small patients group,but the efficacy of MMF in LN still needs to be confirmed. METHODOLOGY This study included 17 biopsy proven active diffuse proliferative lupus nephritis(LN IV)patients (female 15,male 2,mean age 33±8y)in whom previous intravenous cyclophosphamide treatment had been proven ineffective or in whom the clinical course was refractory or complicated.MMF was administered at 0 75~2 0 g/d for 3 to 9 months(average 4 35±1 5 months).Clinical and renal pathological changes were assessed. RESULTS ParametersPre Post Protein excr↓50%(%)82 4Protein excr(g/d)3 5±1 31 1±0 9 Hematuria(%)10058 8Renal failure(%)29 4a11 7Anemia(%) a82 441 2 ANA+(%)82 435 3 A dsDNA+(%)58 80  Cryoglobulinemia(%)82 112 5  SLAM b8 5±3 61 7±1 1   P 0 05,  P 0 01 vs .Pre .a:3/5 patients required HD;b:SLAM Systemic Lupus Activity Measurement Eight patients were rebiopsied after the treatment for 3 months.Renal histology in these patients showed that activity index was significantly reduced from 6 5±1 5 to 1 2±0 7,infiltrated monocytes decreased from 10 8±4 8 to 1 4±1 2 per glomerulus.Major adverse reactions included pneumonia(11 8%),herpes zoster(11 8%)and gastrointestinal symptoms(35 3%). CONCLUSION MMF is an effective immunosuppressant in the treatment of refrectory severe lupus nephritis of the diffuse proliferative type.Its efficacy is shown by the inhibition of auto antibodies and cryoglobulinemaia production,diminishment of glomerular cellular infiltration,crescent formation,reduction of proteinuria,hematuria and improvement of renal function.The most untoward side effect is the secondary infection,a special attention should be paid to it.
【CateGory Index】: R593.242.05,
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