Abstract
Background: Patients with nephrotic syndrome are treated initially with corticosteroids. Tacrolimus is an important alternative for children who have frequent relapses or who are resistant to steroids. The relationship between the tacrolimus level and drug efficacy is unknown in these circumstances. We conducted this retrospective review to determine this relationship in patients with minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS).Methods: A retrospective chart review was performed on patients diagnosed with MCNS or FSGS at Cohen Children’s Medical Center who were treated with tacrolimus. Results: Seventeen patients with MCNS were identified, mean age 4.6±3.6 years, who were treated with tacrolimus for 36±28 months. No relationship between the initial drug level and time to remission was found. There was a direct correlation between the average tacrolimus level during treatment and the number of relapses per month (P < 0.02). Twelve patients with steroid resistant FSGS, mean age 9.0±5.5 years, received tacrolimus for 21±23 months. There was no relationship between paired levels of proteinuria and the trough tacrolimus concentration determined at the time of assessment of proteinuria. Conclusion: There is no dose response relationship to justify the use of higher tacrolimus dosages in the treatment of MCNS or FSGS.
Published Version
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