The Clinical Effects Of Tacrolimus Combined With Glucocorticoids On Idiopathic Membranous Nephropathy

Background: Although idiopathic membranous nephropathy(IMN) is a common cause of adult-onset nephrotic syndrome, its treatment remains controversial. Recent studies show tacrolimus is effective in the treatment of IMN. This study was performed to evaluate the efficacy and safety of tacrolimus(TAC) combined with glucocorticoids in patients with IMN.Method: 20 patients with biopsy-proven IMN were collected in thisretrospective study. Tacrolimus was given at 0.05-0.1mg/kg/day initially and adjusted to a blood trough level at 4-8ug/L for 6 months and then reduced to 2-4ug/L in the subsequent 6 months.The primary outcome was the remission rate,whereas the secondary outcomes included the changes in serum albumin levels and daily urinary protein levels,and adverse events.Result:After three months treatment of TAC combined with glucocorticoids,the serum albumin levels had a significant improvement(23.57±4.51g/Lvs33.16±6.87g/L,P<0.05), and the proteinuria had a significant decrease(6.74±3.08g/dvs3.69±2.65g/d,P<0.05). At the 6-months therapy, the serum albumin levels was significantly improved(23.57±4.51g/L vs 36.96±6.63g/L, P<0.05), and the proteinuria was significantly decreased(6.74±3.08g/d vs2.48±2.21g/d,P<0.05). At the 12-months therapy, the serum albumin levels was significantly improved(23.57±4.51g/L vs 37.30±7.62g/L, P<0.05), and the proteinuria was significantly decreased(6.74±3.08g/d vs2.19±2.10g/d,P<0.05). At the end of the 18-months therapy, the serum albumin levels was significantly improved(23.57±4.51g/L vs 39.84±4.31g/L, P<0.05), and the proteinuria was significantly decreased(6.74±3.08g/d vs1.26±1.42g/d,P<0.05). After 18 months of therapy, complete remission(CR) was achieved in 45% of the patients and partial remission(PR) in 40%, yielding a final response rate of 85%. Two patients experienced relapses during the 12 th months of follow-up. There were no significant changes in creatinine,transaminase and glucose in blood.Thepatients had no serious adverse reactionsduring the treatment.Conclusion: In this study, treatment with tacrolimus and glucocorticoidsshowed a good efficacy with mild adverse reactions in patients with IMN.