Effects Of Tacrolimus (FK506) Combined With Glucocorticoid In The Treatment Of Refractory Nephrotic Syndrome

Objective：To compare therapeutic effect and safety of Refractory Nephrotic Syndrome treated bytacrolimus in combination with glucocorticoid.Methods:In20cases of Refractory Primary Nephrotic Syndrome patients, were given tacrolimusin combined with glucocorticoid treatment, after24weeks of treatment, observation andcomparison of curative effect and safety of different treatment.Results:At the end of treatment, the total effective rate was95%, the complete remission rate was55%. On behalf of clinical recovery index data, to observe the full course of treatment of24hurinary protein decreased, after2weeks of treatment was decreased significantly (P <0.05),was significantly decreased in the8week,12weeks and24weeks (P <0.01). After2weeksof treatment in patients with serum albumin was significantly increased (P <0.05),4weeksincreased significantly (P <0.01). White blood cells at2weeks,4weeks and24weeksincreased significantly,8weeks and12weeks increased significantly. Total cholesterol at theend of treatment compared with before treatment were statistically significant (P <0.05).Triglycerides in the twelfth week of treatment compared with before treatment wassignificantly decreased (P <0.05), at the end of treatment than before treatment significantly decreased (P <0.01). In the course of treatment in patients with creatinine, urea nitrogen,blood pressure, platelet, hemoglobin, red blood cell, alanine aminotransferase, aspartateaminotransferase, ALP smooth fluctuations. In the course of treatment according to themonitoring of blood drug concentration to adjust the dosage of tacrolimus, concentrations oftacrolimus average value control in5.53-6.79ug/L. During the treatment of high bloodpressure, creatinine, high blood sugar, avascular necrosis of the femoral head, liver damageand the incidence rate of adverse reaction is low. We see from the above results, in thetreatment of refractory nephrotic syndrome, tacrolimus glucocorticoid combined with rapidonset, high efficiency, less adverse reaction, the light degree.Conclusion:(1) From the clinical curative effect,at the end of treatment,he total effective rate was95%, the complete remission rate was55%, has obvious therapeutic effect.(2) observed in the laboratory indexes and clinical manifestations in patients with thecourse of treatment, patients white blood cells increased obviously with the increase in theincidence and treatment; blood pressure, renal function deterioration, high blood sugar,avascular necrosis of the femoral head, liver damage and other adverse reactions to low.(3) During the treatment of one patient had elevated blood sugar, blood sugar afterapplication of hypoglycemic drugs is still maintained at a high level, and nephrotic syndromewithout relief of symptoms, treatment is invalid, the patients before treatment and high bodymass index, are obese, consider this patient had elevated blood sugar and no treatment effectassociated with obesity, but still need further clinical verification.(4) compared to domestic and international relevant reports, efficacy of tacrolimus inrenal lesions of lupus nephritis in immune correlation has been recognized, but in nephroticsyndrome efficacy and safety need long-term, large scale clinical trials confirm.