ESPN 51th Annual Meeting

ESPN 2018


 
Efficacy and Side Effects of Mycophenolate Mofetil (MMF) therapy in children with Steroid Dependent Nephrotic Syndrome (SDNS) in a Tertiary Paediatric Nephrology Centre in Sri Lanka
NIMALIKA SANDAMALI HETTIARACCHI 1 MADURI RAJA 2 UMESHI ISHANIKA KARUNADASA 2 RUCHIRA RUWANTHIKA KARUNARATNE 2 THILINI SURENIKA MUNASINGHE 2 SHAMALI ABEYAGUNAWARDENA 3 RANJIV SHENAL THALGAHAGODA 2

1- ACCIDENT AND EMERGENCY UNIT, SIRIMAVO BANDARANAYAKE SPECIALIZED CHILDRENS HOSPITAL, PERADENIYA, SRI LANKA
2- DEPARTMENT OF PAEDIATRICS, UNIVERSITY OF PERADENIYA, PERADENIYA, SRI LANKA
3- 3DEPARTMENT OF MEDICINE, UNIVERSITY OF PERADENIYA, PERADENIYA, SRI LANKA
 
Introduction:

MMF has been shown to be a well-tolerated drug which could maintain prolonged remission in patients with SDNS. As a selective reversible inhibitor of inosine monophosphate dehydrogenase that inhibits de novo synthesis of purines, MMF is known to have a steroid sparing effect. This study aimed to determine the effect of MMF in reducing relapses in Sri Lankan children with SDNS and to ascertain the incidence of side effects of MMF in this population.

Material and methods:

Children between 1-18 years of age with SDNS who have been treated with MMF for more than three months at the paediatric nephrology unit, Teaching Hospital Peradeniya were selected and reviewed retrospectively.  Children who have previously received immunosuppressive therapy other than prednisolone, cyclophosphamide, Cyclosporin A and levamisole and those who were on MMF for indications other than idiopathic NS (e.g. lupus nephritis; renal transplant) were excluded. Children and parents were interviewed and their patient-held health records, including their ‘nephrotic syndrome diary’ were reviewed. Data was collected twice a week using pretested questionnaires, in the Nephrotic Syndrome Clinic for a period of 8 weeks. Results were analysed using SPSS version 23.

Results:

35 children who met the selection criteria were included. 26 (74.29%) were male and 9 (25.71%) were female (median age = 9.7 years.). The mean number of relapses in the year prior to starting MMF and the year after starting MMF were 3.54 and 1.83 respectively. The reduction in the relapse rate after being on MMF was statistically significant (p=0.009). The child’s age or gender did not impact the relapse rate (p>0.5). The Most common side effect observed was arthralgia (20%) and the least common ones were vomiting, dyspnoea and dizziness (3%).

Conclusions:

  MMF was effective in reducing the relapse rates of children with SDNS in the Sri Lankan setting, despite the reported side effects.