IgA nephropathy (IgAN) is the commonest primary glomerulonephritis worldwide. In Hong Kong,
IgAN accounts for approximately 30% of all primary glomerular diseases, and a significant
proportion of young patients (< 50 years of age) on dialysis therapy are sufferers of primary
IgAN. To date, no specific therapeutic agent has been consistently shown to halt the
progression of IgAN to end-stage renal failure, particularly in patients with persistent
significant proteinuria and the presence of chronic tubulointerstitial inflammation on kidney
biopsy. In recent years, angiotensin-converting enzyme inhibitors (ACEI) have been found
capable of significantly reducing proteinuria in some IgAN patients, while others,
particularly those with the ACE DD genotype, showed either absent or unsatisfactory response
to angiotensin blockade. Mycophenolate mofetil (MMF) is a marketed immunosuppressive drug
which acts by releasing mycophenolic acid (MPA) to inhibit the de novo pathway of purine
synthesis, and hence is relatively selective for lymphocytes. Apart from being efficacious
for the prophylaxis of renal allograft rejection and for the induction of remission in severe
lupus nephritis, MMF has been anecdotally reported to avert progression to allograft failure
in recurrent IgAN of the transplanted kidney. Data on the clinical efficacy of MMF in the
treatment of primary IgAN, however, is lacking. In the current proposal, we aim to study the
clinical efficacy of MMF in patients with biopsy-proven IgAN and clinically significant
proteinuria despite angiotensin blockade. Patients will be followed up for at least 5 years
to track any survival difference between groups.
Phase:
Phase 4
Details
Lead Sponsor:
The University of Hong Kong
Collaborators:
Queen Mary Hospital, Hong Kong United Christian Hospital