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Mycophenolate mofetil treatment for acute interstitial nephritis
Original article
Preddie DC et al . (2006) Mycophenolate mofetil for the treatment of interstitial nephritis. Clin J Am Soc Nephrol 1 : 718–722
Acute interstitial nephritis (AIN) is often caused by an allergic reaction to a medication; it can also be associated with autoimmune conditions and with various infections. Most causes of AIN seem to respond to immunosuppressants such as corticosteroids, but some patients are resistant to or intolerant of corticosteroid therapy. Preddie et al . have investigated whether the immunosuppressant mycophenolate mofetil (MMF) could be useful in such patients.
The study included eight patients with biopsy-proven AIN who had received 
6 months of corticosteroid treatment but had suffered relapses, intolerance or resistance to corticosteroid therapy. Patients received twice-daily MMF doses ranging from 500 mg to 1,000 mg.
After a mean of 28 months of follow-up (range 14–40 months, with a mean of 24 months of MMF treatment), mean serum creatinine level decreased from 2.3 mg/dl to 1.6 mg/dl (203 
mol/l to 141 
mol/l). Six of eight patients showed improvement in renal function—defined as a decrease in serum creatinine level of 
0.3 mg/dl (26.5 
mol/l)—following MMF treatment. Serum creatinine levels remained stable in the other two patients. At their final follow-up visit, all patients had discontinued corticosteroids, and five patients had discontinued MMF therapy. One patient had a myocardial infarction during MMF therapy and died of cardiac disease, but this was thought to be unrelated to MMF. No serious adverse effects of MMF were reported.
Although further studies are needed, MMF appears to be a useful alternative treatment for patients with steroid-resistant or steroid-intolerant AIN, and might be a good first-line option in patients with conditions such as obesity or diabetes, for whom steroid treatment is undesirable.
霉酚酸酯治疗急性间质性肾炎
急性间质性肾炎通常由药物过敏反应导致，并常常联合自身免疫因素以及感染因素。大部分的急性间质性肾炎看来对免疫抑制剂有效，比如皮质激素，但一些病人对激素抵抗或激素依赖。 Preddie 研究了 MMF 是否对这部分病人有效。
这个研究包括 8 个肾活检证明是急性间质性肾炎的病人，而且接受了 6 个月的皮质激素治疗后复发、激素依赖或是激素抵抗的。这些病人接受 MMF 2 次 / 日，剂量从 500mg 到 1000mg 不等。
在平均 28 个月的随访中（ 14-40 个月， MMF 治疗平均 24 个月），血清肌酐平均从 2.3mg/dl （ 203umol/L ）下降至 1.6mg/dl （ 141umol/L ）。其中 6 个病人显示 MMF 治疗后肾功能改善，血清肌酐确切减少 0.3mg/dl 。其他 2 个病人血清肌酐值保持稳定。在最后的随访中，所有的病人停用了激素， 5 例病人停用了 MMF 治疗， 1 例病人在 MMF 治疗期间患心肌梗塞并死于心脏病，但是考虑与 MMF 无关。没有关于 MMF 的不良反应报告。
虽然还需要进一步的研究，但是MMF已经在激素依赖或激素抵抗型的急性间质性肾炎的病人中显示了可能有用的治疗方案，可能是某些例如肥胖、糖尿病等对糖皮质激素禁忌的特殊病人较好的一线用药。
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