Abstract
Objective To explore the clinical effect of Tacrolimus in pediatric refractory nephrotic syndrome. Methods One hundred and ninety-one children with refractory nephrotic syndrome in Nanjing General Hospital of Nanjing Military Region, People's Liberation Army, were enrolled from January 2010 to December 2013, including 101 cases of steroid-dependent nephrotic syndrome, 73 cases of steroid-dependent nephrotic syndrome, and 17 cases of frequently relapsing nephrotic syndrome.Tacrolimus was applied to all the patients.The plasma concentrations of Tacrolimus during the treatment were measured and glucocorticoid tapered or some other immunosuppressants discontinued based on clinical judgment.Relevant clinical changes and laboratory test values were observed before treatment and in weeks 4, 8 after treatment. Results The overall remission rate was 86.9%(166/191 cases) after 8 weeks treatment of Tacrolimus.The minimum effective time was 6 days.Serum albumin and cholesterol significantly improved(all P<0.01), and proteinuria also diminished markedly(t=20.14, P<0.01). One hundred and fifteen patients underwent renal biopsy.The treatment with Tacrolimus did well in minimal change nephropathy(MCN)[remission rate was 90.5%(18/21 cases)], but mesangial proliferative glomerulonephritis(MsPGS) was inferior in its efficacy(87.7%)(57/65 cases). The use of Tacrolimus in focal segmental glomerulosclerosis(FSGS), membranous nephropathy(MN) and membranoproliferative glomerulonephritis(MPGN) also produced remission to some extent.Thirty-two cases were analyzed by way of Tacrolimus metabolic genotype.The remission rate of 3/3 or 1/3 Tacrolimus metabolic genotype was 75.0%(21/28 cases), but 4 cases with 1/1 tacrolimus metabolic genotype did not remit after 4 weeks treatment.The adverse reactions of tacrolimus were mild, mainly slight digest tract symptoms, transient kidney injury, dysglycemia, headache, dysphoria etc, which did not influence the treatment. Conclusions Tacrolimus has a gold application prospect, and is a powerfully effective immunosuppressant with clinical efficacy and less side effects for refractory nephritic syndrome in children. Key words: Tacrolimus; Child; Nephrotic syndrome, refractory
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