Biopsy-proven resolution of immune complex-mediated crescentic glomerulonephritis with mycophenolate mofetil therapy in an allograft

We report biopsy-proven resolution of immune-complex-mediated crescentic glomerulonephritis (ICMCGn) using mycophenolate mofetil (MMF), Therapy with steroids and cyclophosphamide failed twice in a 39-year-old white man who developed ICMCGn in his native kidneys, and subsequently in a human lymphocyte antigen-identical renal allograft, When he developed ICMCGn in a second, now cadaver, allograft, he was treated with steroids and MMF instead, His serum creatinine (Cr) improved from 4.4 mg/dL to 2.1 mg/dL, A biopsy 21 months later showed him to be free of glomerular disease. MMF is known to be an effective immunosuppressant, In our patient, ICMCGn, a notoriously difficult entity to treat effectively, seemingly resolved with MMF therapy. We suggest that MMF may be effective in the treatment of immunologically mediated pre-end-stage renal disease (ESRD), It should be considered in any posttransplantation setting where the original cause of organ failure is known to be immunologically mediated and likely to recur. (C) 1999 by the National Kidney Foundation, Inc.