Tülin GÜNGÖR, Fehime KARA EROĞLU, Evrim KARGIN ÇAKICI, Fatma YAZILITAŞ, Eda Didem KURT-SUKUR, Gökçe CAN, Semanur ÖZDEL, Evra ÇELİKKAYA, Deniz KARAKAYA, Mehmet BÜLBÜL

Çocukluk Çağı Steroid Duyarlı Nefrotik Sendromda Mikofenolat Mofetil Tedavisi: Tek Merkez Deneyimi

Amaç: Mikofenolat mofetilin çocukluk çağı steroide duyarlı nefrotik sendromda remisyonu sürdürme ve relaps sayısını azaltmadaki etkinliğinin belirlemesi amaçlandı. Ayrıca MMF’in büyüme ve kan basıncı üzerindeki etkileri değerlendirildi. Gereç ve Yöntemler: Bu retrospektif, tek merkezli gözlemsel çalışma, 2009-2019 yılları arasında hastanemiz çocuk nefroloji kliniğinde MMF ile tedavi edilen steroide duyarlı nefrotik sendromlu hastaları içermektedir. Bulgular: Çalışmamızdaki 10 hasta steroide bağımlı nefrotik sendrom, 6 hasta sık relaps nefrotik sendromdu. Ortalama hastalık süresi 93.3 ± 25.0 ay ve tanıdan sonra ortalama MMF başlangıç süresi 33.9 ± 16.7 aydı. On hastanın nüks oranında %50 veya daha fazla azalma görüldü ve prednizolon tedavisi 8 hastada 6 ay veya daha uzun süre kesildi. Bir önceki yıla kıyasla, 12 aylık MMF tedavisinden sonra nüks oranında %52,7 ve yıllık kümülatif steroid dozunda %36.6 azalma oldu. Mikofenolat mofetil tedavisi sonrası hastaların boy z skoru ve ortanca ofis sistolik kan basıncı standart sapma skorları iyileşti (sırasıyla p = 0.003, p = 0.01). Sonuç: Mikofenolat mofetil, steroid duyarlı nefrotik sendromda nüks oranlarını, kümülatif steroid dozunu azaltarak büyüme ve kan basıncı ölçümleri üzerine olumlu etkilere neden olur.

Anahtar Kelimeler:

Kan basıncı, Çocukluk çağı, Mikofenolat mofetil, Büyüme

Mycophenolate Mofetil Treatment in Childhood Steroid-sensitive Nephrotic Syndrome: Single Center Experience

Objective: We aimed to investigate the efficacy of mycophenolate mofetil (MMF) for maintaining remission and reduce the number of relapses in childhood steroid-sensitive nephrotic syndrome. The effects of MMF on growth and blood pressure parameters were also evaluated. Material and Methods: This retrospective, single-center observational study included patients with steroid-sensitive nephrotic syndrome who were treated using MMF between 2009 and 2019 in the Department of Pediatric Nephrology in our hospital. Results: Ten patients had steroid-dependent nephrotic syndrome; six patients frequently had relapsing nephrotic syndrome in this study. The mean duration of the disease was 93.3 ± 25.0 months and the mean duration of the MMF onset was 33.9 ± 16.7 months after diagnosis. Ten patients showed a 50% or greater reduction in the relapse rate and the prednisolone treatment was discontinued in eight patients for six months or more. Compared to the previous year, before the start of the MMF treatment, there was a 52.7% reduction in the relapse rate and a 36.6% reduction in the cumulative annual dose of steroid after 12 months of MMF treatment. The height z score and the median office systolic blood pressure standard deviation scores of the patients improved after MMF treatment (respectively p = 0.003, p = 0.01). Conclusion: The findings suggest that MMF may lead to decreased relapse rates and cumulative steroid dose, which has a positive effect on growth and blood pressure parameters in steroid-sensitive nephrotic syndrome.

Keywords:

Blood pressure, Childhood, Growth, Mycophenolate mofetil,

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