Mycophenolate Mofetil for Kidney Disease
When we encounter refractory kidney disease, or steroid effect is not obvious, we often use immunosuppressive agents to suppress kidney inflammation and reduce urinary protein. Today we are going to talk about an immunosuppressive agent, mycophenolate mofetil (also known as Cellcept).
What is mycophenolate mofetil? How to use it?
In 1995, mycophenolate mofetil came out and quickly became popular in nephrology.
Cyclophosphamide was commonly used in nephrology (now also commonly used) because of its remarkable effect in the treatment of refractory nephropathy. However, cyclophosphamide is a cytotoxic drug, with adverse reactions such as hematotoxicity, gonadal toxicity, bladder toxicity, hyponatremia and increased cancer risk. The most troubling thing is gonadal toxicity, so it can not be used for a long time. When accumulated to a certain dose, it will become infertile and menopausal, affecting fertility. Therefore, young people are very resistant to it.
Mycophenolate mofetil has no gonadal toxicity, and is effective in treating nephropathy and reducing urinary protein. For example, in the treatment of Lupus Nephritis, early studies have shown that mycophenolate mofetil overwhelms commonly used drugs when lupus nephritis is active. When it firstly came into being, it became a magic drug in the Department of Rheumatology and nephrology.
However, the shortcomings of mycophenolate mofetil were exposed after a long time of use.
1. Side effects. The first is its immunosuppressive effect, which may cause a variety of infection problems, including a creepy Pneumocystis carinii infection, although only a very small number of people will occur, but the mortality rate is very high. It may also cause adverse reactions such as anemia, nausea, abdominal pain, tumors (which has low incidence with conventional dosage). It seems that besides the absence of gonadal toxicity, side effects are not as good as cyclophosphamide.
2. Effect. After a large number of experimental studies, we found that the effect of mycophenolate mofetil on lupus nephritis is not much different from cyclophosphamide, and the data comparison has no statistical significance.
3. Expensive. It's much more expensive than cyclophosphamide.
After calming down, now experts in the field of nephropathy regard mycophenolate mofetil more rationally: the effect is worth affirming, but the apparent efficiency is not as outstanding as previously imagined, and side effects also need to be considered.
What kinds of kidney disease can mycophenolate mofetil treat?
1. Type III or IV lupus nephritis.
Lupus mostly occurs in women of childbearing age. This group has reproductive needs, so cyclophosphamide can not be used for a long time. Therefore, when the cumulative amount of cyclophosphamide is approaching the damage of ovaries, mycophenolate mofetil can be used instead to continue to improve the condition.
Mycophenolate mofetil can be used in patients with FSGS who are unwilling to use or cannot use calmodulin inhibitors such as hormones and/or cyclosporine, or when the efficacy is poor and side effects are serious.
3. Membranous proliferative nephropathy
This is a very refractory nephropathy, and there are few effective drugs for it. When steroids, cyclophosphamide and cyclosporine do not work, mycophenolate mofetil can be used as an alternative.
4. IgA Nephropathy with poor pathology and manifestation of massive proteinuria
When mycophenolate mofetil is needed, the kidney disease is often serious and many drugs are ineffective.
There are two points to note when using mycophenolate mofetil:
First, to prevent infection, after all, the immunity will decline after the use of drugs, and live vaccines can not be injected (excluding cold vaccines, influenza vaccines and pneumococcal vaccines, which are inactivated).
Second, contraception. If you intend to conceive, from six weeks before pregnancy to breast-feeding, mycophenolate mofetil can not be used, because it may lead to abortion and fetal malformation.
At present, mycophenolate mofetil is seldom used as the preferred drug in nephrology, but it still occupies an important place. When the refractory nephropathy can not be solved by steroids and other drugs, mycophenolate mofetil may relieve patients' troubles. For more information on kidney disease treatment, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***