The Efficacy Of Prednisolone Plus Tacrolimus For The Treatment In Adults With Idiopathic Membranous Nephropathy

Objective:To retrospectively analyze the clinical data of 35 patients with Idiopathic membranous nephropathy（IMN）,observe the effect of low-dose tacrolimus combined with glucocorticoid therapy on IMN,as Clinical treatment IMN provides a certain reference basis.Methods:1.Retrospective analysis was performed on the inpatient and outpatient treatment of 35 IMN patients who met the inclusion and exclusion criteria in the department of nephrology of The 940^th Hospital of Joint Logistics Support force of Chinese People’s Liberation Army on January 1,2016 to December 31,2019.2.Observing the change of the 35patients 24 hours urinary protein quantitative（24h-UP）,serum albumin（ALB）,creatinine（CRE）,estimated glomerular filtration rate（eGFR）,triglyceride（TG）,Total cholesterol（TC）,Urinary protein creatinine ratio,glycemic,Uric Acid,glutamic-pyruvic transaminase,glutamic oxalacetic transaminase,and recording the dose,blood concentration and adverse of tacrolimus.3.SPSS 26.0 statistical software was used for all data statistics and analysis.Obey the normal distribution of measurement data adopt Mean±standard deviation（x±s）,or the measurement data in the median and interquartile spacing（M,（P25,P75））,percentage and rate was used to represent count data,Paired T test or rank sum test was used to compare the difference of indexes before and after treatment,p<0.05 for the difference was statistically significant.Results:1.Among the 35 patients treated with tacrolimus,21 males and 14 females,aged 18-78years,with a median age of 42 years.The remission rate was 40.0%,51.4%,60.0%,68.57%,80.00%at follow-up for 1,2,3,6,12 months,There was no significant difference in remission rate between 1,2,3,6 and 12 months（P>0.05）;Follow-up for one year,mean remission time is（2.60±1.79）months;2.Observation of IMN patients after TAC treatment showed a significant decrease in 24h-UP,PCR compared with that before treatment,and a significant increase in ALB compared with that before treatment,indicating a statistically significant difference in 24h-up,ALB compared with that before treatment（P<0.05）.No significant difference in CRE,eGFR,TG,TC,GLU,UA,AST,ALT（P>0.05）.3.In this study,TAC concentration monitoring was performed in a total of 40 cases.Among them,TAC dose of 1mg was monitored in 17 cases with a concentration range of（0.8¹2.3）ng/mL and an average concentration of（3.4².6）ng/ml.TAC dose of 2mg was monitored in 23 cases,with a concentration range of（0.7¹3.1）ng/mL and an average concentration of（3.7 2.5）ng/ml.4.The recurrence rate was 2.86%and 8.57%,respectively,after follow-up for 6 months and 12 months.5.During the 12-month follow-up,5（14.29%）of the 35 patients had 13 reversible adverse reactions(7 times（53.8%）of infection,3 times（23.0%）of liver enzyme elevation（1 time（7.7%）of thrombocytopenia,1 time of hyperuricemia and 1 time of blood urea nitrogen elevation）.The adverse reactions of the patients were all relieved after drug therapy without serious consequences.Conclusion:The blood concentration of tacrolimus in the range of 3⁵ng/ml can significantly reduce the proteinuria and increase the serum albumin level in patients with idiopathic membranous nephropathy presenting as nephrotic syndrome,which may provide a certain reference for the clinical application of tacrolimus in patients with idiopathic membranous nephropathy.