perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2026-71-4-25-32perinatology-2468Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSФармакологический мониторинг микофеноловой кислоты в крови у детей с нефротическим синдромомPharmacological monitoring of mycophenolic acid in blood in children with nephrotic syndromehttps://orcid.org/0000-0002-0942-0103МорозовС. Л.MorozovS. L.

Морозов Сергей Леонидович — к.м.н., в.н.с. отдела наследственных и приобретенных болезней почек им. профессора М.С. Игнатовой НИКИ педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России, доцент кафедры госпитальной педиатрии № 2 института материнства и детства ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России.

125412, Москва, ул. Талдомская, д. 2

125412, Moscow; 117997, Moscow

mser@list.ruhttps://orcid.org/0000-0003-2162-1992ОбуховаВ. А.ObukhovaV. A.

Обухова Варвара Александровна — н.с. отдела наследственных и приобретенных болезней почек им. профессора М.С. Игнатовой Научно-исследовательского клинического института педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России.

125412, Москва, ул. Талдомская, д. 2

125412, Moscow

https://orcid.org/0000-0002-0702-4932ПриходинаЛ. С.PrikhodinaL. S.

Приходина Лариса Серафимовна — д.м.н., проф. кафедры педиатрии им. академика Г.Н. Сперанского РМАНПО Минздрава России; заведующая отделом наследственных и приобретенных болезней почек им. профессора М.С. Игнатовой Научно-исследовательского клинического института педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России.

125412, Москва, ул. Талдомская, д. 2

125412, Moscow; 125993, Moscow

Научно-исследовательский клинический институт педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава России; ФГАОУ ВО «Российский национальный исследовательский университет им. Н.И. Пирогова» Минздрава РоссииРоссияResearch and Clinical Institute for Pediatrics and children surgery; Pirogov Russian National Research Medical UniversityRussian FederationНаучно-исследовательский клинический институт педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава РоссииРоссияResearch and Clinical Institute for Pediatrics and children surgeryRussian FederationНаучно-исследовательский клинический институт педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава России; ФГБОУ ДПО «Российская Медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияResearch and Clinical Institute for Pediatrics and children surgery; Russian Medical Academy of Postgraduate EducationRussian Federation2026051020267142532Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20262026Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/2468

Идиопатический нефротический синдром у детей является наиболее распространенной формой гломерулярной патологии и часто требует длительной иммуносупрессивной терапии вследствие стероидной зависимости и частых рецидивов заболевания. Микофенолата мофетил рассматривается как один из предпочтительных стероид-сберегающих препаратов благодаря благоприятному профилю безопасности и подтвержденной эффективности в снижении частоты рецидивов нефротического синдрома у педиатрических пациентов. Активный метаболит микофенолата мофетила — микофеноловая кислота — характеризуется выраженной межиндивидуальной вариабельностью фармакокинетики, зависящей от возраста, уровня альбумина, функции печени и почек, сопутствующей терапии и генетических факторов, что обосновывает необходимость терапевтического лекарственного мониторинга. В обзоре рассматриваются современные данные о фармакокинетике и фармакодинамике микофеноловой кислоты у детей с нефротическим синдромом, целевых значениях экспозиции (AUC) и преддозовой концентрации (C0), а также их связи с клинической эффективностью и риском рецидивов. Особое внимание уделено стратегиям ограниченного отбора проб (limited sampling strategy — LSS), позволяющим надежно оценивать экспозицию микофеноловой кислоты по ограниченному числу временных точек, и возможностям популяционного фармакокинетического моделирования для индивидуализации дозирования. Обсуждаются перспективы использования активности инозинмонофосфатдегидрогеназы в качестве фармакодинамического маркера, а также необходимость дальнейших проспективных исследований для уточнения оптимальных целевых уровней экспозиции микофеноловой кислоты у детей со стероид-зависимым и часто-рецидивирующим нефротическим синдромом.

Idiopathic nephrotic syndrome in children is the most common glomerular disease in pediatric practice and frequently requires long-term immunosuppressive therapy because of steroid dependence and frequent relapses. Mycophenolate mofetil has emerged as a preferred steroid-sparing agent in international guidelines due to its favorable safety profile and proven efficacy in reducing relapse rates in steroid-dependent and frequently relapsing nephrotic syndrome in children. Its active metabolite, mycophenolic acid, exhibits marked interindividual pharmacokinetic variability influenced by age, serum albumin, kidney and liver function, concomitant therapies, and genetic factors, which underpins the need for therapeutic drug monitoring. This narrative review summarizes current evidence on the pharmacokinetics and pharmacodynamics of mycophenolic acid in pediatric nephrotic syndrome, focusing on target exposure parameters such as area under the concentration–time curve (AUC) and trough levels (C0) and their association with clinical efficacy and relapse risk. Particular attention is given to limited sampling strategies enabling reliable estimation of mycophenolic acid exposure from a small number of timed blood samples, as well as to population pharmacokinetic modeling as tools to individualize dosing in clinical practice. The potential role of inosine monophosphate dehydrogenase activity as a pharmacodynamic biomarker is discussed, and key gaps are highlighted, including the need for prospective trials to define optimal target exposure ranges for mycophenolic acid in children with steroid-dependent and frequently relapsing nephrotic syndrome.

детиидиопатический нефротический синдроммикофенолата мофетилмикофеноловая кислотатерапевтический лекарственный мониторингchildrenidiopathic nephrotic syndromemycophenolate mofetilmycophenolic acidtherapeutic drug monitoringРабота выполнена в рамках финансирования Гос.задания «Фармакокинетические и фармакодинамические критерии эффективности и безопасности иммуносупрессивной терапии первичного нефротического синдрома у детей». № 26031018450-1 (2026–2028)This work was carried out within the framework of the statefunded project “Pharmacokinetic and pharmacodynamic criteria for the efficacy and safety of immunosuppressive therapy of primary nephrotic syndrome in children” No 26031018450-1 (2026–2028)ReferencesTrautmann A., Boyer O., Hodson E., Bagga A., Gipson D.S., Samuel S., et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2023;38(3):877– 919. 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The authors declare that there are no conflicts of interest present.