| Background: IgA Nephropathy is a chronic disease and If the disease can,t be controlled, it will gradually develop to chronic renal failure. Delaying and reversing It,s progression is a intractable disease in clinical treatment and substructure investigation. more and more researchers discovered that many factors participate in the pathogenesis of IgA nephropathy, including inheritance,anomalism of immunoglobulin A,the response of immunoglobulin A in Glomerular mesangium et. Among them, immune disorder take the main function in the pathogenesis of the IgA nephropathy.So the basic schedule to the treatment is Immunosuppressive therapy ,including glucocorticoid and immunosuppressant . Immunosuppressive therapy can decreas the generate of immunoglobulin A,alleviate albuminuria and slow down the process of disease,and gain better clinic effect. Although the application of glucocorticoid combined with immunosuppressive drug such as cyclophosphamide,mycoPhenolatemofet ( MMF ),leflunomide(LEF),mizoribine cyclosporine A have obtained commendable effect to somebody.at present, the cognition about their therapeutic effect has,t been concordant. But they are limited because of their serious side effect. Therefore it is very necessary to study a new immunosuppressive drug with a little side effect and good.Objective: In order to study the effect of Tacrolimus(FK506) combined with glucocorticoid on the IgA nephropathy with moderate Proteinuria ,we should observe the changes such as 24 hours Urine protein,serum creatinine , serum glucose and blood pressure et .and these changes are compared with the changes of the control group(given singlet glucocorticoid treatment).TO study the effect and safety of minute dose glucocorticoid combined with Tacrolimus.We wish that we can find the new methods for the treatment of the IgA nephropathyMethod: We choosed the twenty-five IgA nePhroPathy (patho-type LeeII-IV, serum creatinine less than 221umol/L, 24 hours Urine protein exceed 1.0g and less than 3.5g)patients ,among of them,eleven are male,the others are female,age from 16 to 57,mean 36.3, as the objects that they once stay in the hospital from November of 2007 to Octobe of 2008 and were diagnosed the IgA nephropathy by renal biopsy. 14 cases were assigned into control group (given singlet glucocorticoid treatment),11 cases were assigned into treatment group (given combination of Tacrolimus(FK506) and glucocorticoid treatment). 24hours urine total protein,serum creatinine,blood pressure were no obvious diffirence between two groups before therapy. Detect the changes such as 24 hours Urine protein, minotransferase ,serum creatinine , serum glucose and blood pressure, concentration changes of tacrolimus et during the treatment, then obersve treatment effect, side effect and these effects are compared in 2 groups .we should tune-up the concentration according to the result of concentration of the FK506 and sustain it range from 3-5ng/ml. We judge the curative effect : complete remission,partial remission and non-remission. Complete remission Include Urine protein <0.3g/24h and serum creatinine < duplum of the pretherapy. partial remission include 24 hours Urine protein < seventy percent of the pretherapy,and 24 hours Urine protein>0.3g, and serum creatinine < duplum of the pretherapy. non-remission 24 hours Urine protein > seventy percent of pretherapy or serum creatinine >duplum of the pretherapy. effective power=( Complete remission case+ partial remission case)/ total case×100%;complete remission rate= Complete remission case / total case×100%.We conduct the data with t test and rate withχ2 test . We consider it is significant deviation when P<0.05, the contra is non-deviation.Result:3 patients obtained complete remission after 6 months of treatment in the the control group(given singlet glucocorticoid treatment); 8 patients obtained partial remission;3 patients had no response. effective power equal to 78.6% ;complete remission rate equal to 21.4%.we can see that the level of 24 hours urinary protein significantly decreased after 2 months of teeatment , 5 patients occurrenced serum glucose metabolic disorder- hyperglycemia during the treatment, among them, 3 patients relieved through regulation diet and 2 patients through insulin.1 patient occurrenced cough,expectoration and febrility,and relieved after 1 week through anti-infection treatment .8 patients obtained complete remission after 6 months of treatment in the treatment group (given combination of Tacrolimus(FK506) and glucocorticoid treatment); 3 patients obtained partial remission. effective power equal to 100% ;complete remission rate equal to 72.7%. we can see that the level of 24 hours urinary protein significantly decreased after 1 month of teeatment , 2 patients occurrenced serum glucose metabolic disorder- hyperglycemia during the treatment and relieved through regulation diet ; 1 patient occurrenced thrilled in upper limb and relieved through tune-up the concentration of the FK506.Average concentration of tacrolimus remained 3.4-4.7ng/mL in the period of treatment, presented steadily fluctuation.Discussion: at present, it is known to all that many factors participate in the pathogenesis of IgA nephropathy and immune disorder take the main function in the pathogenesis of the IgA nephropathy.including the activation of T lymphocyte amd the Inflammatory reaction caused by cytokine and growth factor. Tacrolimus is a kind of neotype immunosuppressant which play important role in nephropathy by antiinflammatory and immunodepressive.It has been utended in renal transplantation,lupus nephritis,idiopathic nephrotic syndrome,idiopathic membranous nephropathy and has been confirmed effective. glucocorticoid has been utended in the treatment of IgA nephropathy for more than 20 years.Random control study confirmed :It has obvious effective that glucocorticoid control proteinuria for IgA nephropathy with moderate proteinuria, it may attenuate the progression of renal failure and prolong the period to end-state renal failure.so we used glucocorticoid treatment as confer to study the efficacy and safety of Tacrolimus in the treatment of IgA nephropathy. Result was that Complete remission rate after 6 months and effective power after 10 days were significanly different (P<0·05). Tacrolimus can act more quickly and effective than glucocorticoid .the Complete remission rate was higher and the incidence of side effect such as alvi profluvium,high blood pressure,serum creatinine ascensus was roughly identical betwent the two groups ,when Average concentration of tacrolimus remained 3.76-4.35ug/L in the period of treatment.we can see that the clinical curative effect of IgA Nephropathy with Moderate Proteinuria in Tacrolimus(FK506) group was significant and the side effect was slighter.
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