***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Membranous nephropathy is a common cause of nephrotic syndrome ( NS ) in adults . Its treatment is still under debate . METHODS We report our experience in a pilot study using initially low doses of steroids and tacrolimus ( Tac ) . After 3 months of treatment , mycophenolate mofetil ( MMF ) was added if the proteinuria was higher than 1 g/day . RESULTS In accordance with this st and ard , 21 patients entered the study . A proteinuria level lower than 1 g/day was reached at month 3 of therapy with steroids and Tac in 11 patients . These patients continued this treatment for 12 months . MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months . Two patients were withdrawn because of side effects . At the end of the treatment , remission of the NS was present in 15 out of all the patients ( 71.4 % ) . Remission of the NS was complete in eight ( 53.3 % ) patients and partial in seven ( 46.7 % ) others . The remaining four patients did not respond . There were no significant changes in renal function . At a mean time of 23.1 months after treatment was discontinued , 11 ( 73.3 % ) patients had relapsed . CONCLUSIONS In this trial , treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued BACKGROUND Because humoral immunity is believed to play a pivotal role in the pathogenesis of IgA nephropathy ( IgAN ) , a prospect i ve placebo-controlled r and omized study was started in patients with IgAN using mycophenolate mofetil ( MMF ) .  METHODS A total of 34 patients with IgAN were treated with salt intake restriction , angiotensin-converting enzyme ( ACE ) inhibition and MMF 2 g per day ( N= 21 ) or placebo ( N= 13 ) . After 36 months of follow-up clinical , biochemical , and radiologic data were analyzed using linear mixed models for longitudinal data and Kaplan-Meier survival analysis . RESULTS Therapy had to be stopped prematurely in five patients . Two patients ( MMF group ) evolved to end-stage renal disease ( ESRD ) . There was no difference between groups in the percentage of patients with a decrease of 25 % or more in the inulin clearance or with a serum creatinine increase of 50 % or more over 3 years . There was also no significant difference between groups in annualized rate of change of serum creatinine , computed by linear regression analysis . No significant difference was noted between groups for inulin clearance , serum creatinine , proteinuria , blood pressure , or other parameters of renal function . Hemoglobin and C-reactive protein were significantly lower in the MMF group compared with the placebo group . As a function of time , a significant decline in both groups was noted of proteinuria , parenchymal thickness of the kidneys and C3d . CONCLUSION In patients with IgAN at risk for progressive disease , no beneficial effect of 3-year treatment with MMF 2 g per day could be demonstrated on renal function/ outcome or proteinuria . However , larger r and omized studies are needed to confirm or reject these results BACKGROUND The n-3 fatty acids in fish oil affect eicosanoid and cytokine production and therefore have the potential to alter renal hemodynamics and inflammation . The effects of fish oil could prevent immunologic renal injury in patients with IgA nephropathy . METHODS In a multicenter , placebo-controlled , r and omized trial we tested the efficacy of fish oil in patients with IgA nephropathy who had persistent proteinuria . The daily dose of fish oil was 12 g ; the placebo was a similar dose of olive oil .  Serum creatinine concentrations , elevated in 68 percent of the patients at base line , and creatinine clearance were measured for two years . The primary end point was an increase of 50 percent or more in the serum creatinine concentration at the end of the study . RESULTS Fifty-five patients were assigned to receive fish oil , and 51 to receive placebo .  According to Kaplan-Meier estimation , 3 patients ( 6 percent ) in the fish-oil group and 14 ( 33 percent ) in the placebo group had increases of 50 percent or more in their serum creatinine concentrations during treatment ( P = 0.002 ) . The annual median changes in the serum creatinine concentrations were 0.03 mg per deciliter ( 2.7 mumol per liter ) in the fish-oil group and 0.14 mg per deciliter ( 12.4 mumol per liter ) in the placebo group . Proteinuria was slightly reduced and hypertension was controlled to a comparable degree in both groups . The cumulative percentage of patients who died or had end-stage renal disease was 40 percent in the placebo group after four years and 10 percent in the fish-oil group ( P = 0.006 ) . No patient discontinued fish-oil treatment because of adverse effects . CONCLUSIONS In patients with IgA nephropathy , treatment with fish oil for two years retards the rate at which renal function is lost In several studies diets supplemented with fish oil containing a high proportion of omega-3-polyunsaturated fatty acids ( w-3-PUFA ) have been shown to produce beneficial effects , such as a reduction in blood pressure , lipid levels and inflammation , all of which may affect the course of IgA nephropathy . However , the results of hitherto published studies concerning IgA nephropathy have been inconclusive . We therefore carried out a prospect i ve , r and omized , placebo-controlled six-month study with a higher daily dose of w-3-PUFA than used in previous studies . Thirty-two adult patients with biopsy-proven IgA nephropathy and proteinuria completed the study : 15 were assigned to a fish-oil product with a high percentage of w-3-PUFA ( K 85 , with 55 % eicosapentenoic and 30 % docosahexenoic acid ) and 17 to corn oil , 6 g daily of either oil . At the start , no significant differences were found between the two groups ( K85 : 3 females/12 males , mean age 39 years ( range 22 - 64 ) , corn oil : 4 females/13 males , age 42 years ( range 26 - 68 ) . By six months , supplements of K85 result ed in a slight but significant reduction in glomerular filtration rate ( GFR ) compared to the start : 51Cr-EDTA : 63 + /- 22 to 59 + /- 21 ml/min/1.73 m2 ( p < 0.05 ) , creatinine clearance : 91 + /- 31 to 79 + /- 25 ml/min ( p < 0.01 ) , s-creatinine : 131 + /- 39 to 139 + /- 39 mumol/l , whereas no change in GFR was observed in the corn oil group . The urinary total protein and red blood cell excretions were not affected in any of the groups . ( ABSTRACT TRUNCATED AT 250 WORDS A multicentre , r and omized , placebo-controlled study was performed in 39 adult patients with biopsy-proven IgA nephropathy with the aim of comparing the effects of the ACE inhibitor fosinopril and placebo on proteinuria . All patients had normal blood pressure and normal renal function . Proteinuria ranged from 1.0 to 2.5 g/24 h. After a 3-month run-in period , fosinopril and placebo were r and omly administered in two 4-month sequences separated from cross-over treatment by a 1-month interval . The mean values of creatinine clearance did not change during either the placebo or the treatment sequences . The mean values of mean arterial pressure ( MAP ) were significantly lower during the fosinopril sequence ( 90.4 + /- 9.0 mmHg ) than in basal conditions ( 92.8 + /- 9.1 mmHg ) ( P = 0.034 ) . The mean basal values of proteinuria were 1.74 + /- 0.84 g/24 h. They were unchanged during the placebo sequence ( 1.79 + /- 1.20 ) and fell to 1.37 + /- 0.98 g/24 h after 4 months of fosinopril treatment . Using a multivariate statistical analysis , the treatment effect by time on proteinuria was significantly evident only in the fosinopril sequence ( Wilks test , P = 0.033 ) . Changes in protein excretion were not correlated with changes in MAP , baseline plasma renin activity , and urinary sodium excretion . This controlled study shows that fosinopril can significantly reduce proteinuria even in normotensive patients with IgA nephropathy . Obviously , the results of treatment with ACE inhibitors on long-term renal prognosis remain to be eluci date BACKGROUND Treatment of primary glomerular diseases may be unsuccessful or have potential toxicities . Therefore , we evaluated the use of mycophenolate mofetil ( MMF ) for empirical treatment of primary glomerulopathies . METHODS Forty-six patients with biopsy-proven primary glomerulopathies received MMF for > or =3 months as adjunctive or primary treatment .  Median ( range ) 24-hour urine protein to creatinine ratio ( Up/c ) and serum creatinine at the start and end of MMF therapy were compared using the Wilcoxon signed-ranks test . RESULTS Overall , the median Up/c decreased from 4.7 ( range < 0.1 , 20.3 ) to 1.1 ( < 0.1 , 14.3 ; P < 0.001 ) at the end of MMF treatment with no significant change in median serum creatinine 1.3 ( 0.6 to 6.1 ) to 1.2 ( 0.5 to 6.5 ) mg/dL. Median serum albumin increased from 3.4 ( 1.4 , 4.6 ) to 4.1 ( 1.7 , 48 ) g/dL ( P < 0.001 ) and the median serum cholesterol decreased from 270 ( 148 , 795 ) to 220 ( 140 , 309 ) mg/dL ( P < 0.001 ) post-treatment . For those with minimal change disease , a complete steroid withdrawal was accomplished in 5/6 steroid dependent patients . Focal segmental glomerulosclerosis ( FSGS ) patients had a median Up/c that decreased from 2.7 ( 0.1 , 20.3 ) to 0.8 ( < 0.1 , 8.2 ; P = 0.001 ) in 18 patients . In membranous nephropathy ( MN ) patients , the median Up/c decreased from 7.3 ( 0.1 , 18.5 ) to 1.5 ( < 0.1 , 14.3 ) ( P = 0.001 ) in 17 patients . No significant change in median serum creatinine was detected in FSGS or MN patient groups during treatment . CONCLUSIONS Empirical MMF therapy in the majority of patients with primary glomerulopathies was well tolerated and achieved the goals of steroid withdrawal , improvement of nephrotic syndrome , and stabilization of renal function BACKGROUND The therapy of nephrotic syndrome in focal segmental glomerulosclerosis ( FSGS ) is still a matter of controversy . METHODS We performed a prospect i ve r and omized study of the treatment of nephrotic syndrome due to FSGS . We compared 2 specific treatment protocol s to assess the effect of treatment on proteinuria and renal function .  Fifty-seven patients were r and omly assigned to 2 groups : group 1 ( n = 34 ) received steroids and cyclosporine , and group 2 ( n = 23 ) received steroids and chlorambucil for 6 months . When treatment was refractory to chlorambucil , the patients in this group were treated with cyclosporine .  Creatinine , blood urea nitrogen , proteinuria , lipids , and arterial hypertension were monitored at regular intervals . RESULTS Patients showed a mean serum creatinine of 1.5 + /- 0.2 mg/dL ( 132.6 + /- 17.7 micromol/L ) and proteinuria of 4.8 + /- 2.8 g/24 h with no differences between the groups . At the end of the chlorambucil therapy , patients in group 2 had creatinine levels of 1.8 + /- 0.6 mg/dL ( 159.1 + /- 53 micromol/L ) and proteinuria levels of 3.4 + /- 1 g/24 h. All patients in this group were given cyclosporine . After 4 years the mean creatinine level in group 1 was 1.7 + /- 0.4 mg/dL ( 150.3 + /- 35.4 micromol/L ) and the proteinuria level was 2.5 + /- 1 g/24 h. In group 2 , the mean creatinine level was 1.9 + /- 0.6 mg/dL ( 168 + /- 53 micromol/L ) ( not significant [ NS ] ) and the mean proteinuria level was 2.3 + /- 1.1 g/24 h ( NS ) . Full remission occurred in 23 % of the patients in group 1 ( n = 8) and 17 % of the patients in group 2 ( n = 4 ; NS ) . Partial rem 
    Output:
    
In the two trials with subjects having moderate to high risk for progressive disease , MMF did not demonstrate any significant difference in retarding the decline in renal function and proteinuria reduction .
CONCLUSION No benefit was seen in moderately-advanced IgAN treated with MMF .
In a selected group of patients with less advanced disease , MMF was effective in proteinuria reduction .