Clinical Application Of Tacrolimus With Low-dose Prednisone In21Children With Steroid-resistant Nephrotic Syndrome

Objective To analyze and evaluate the efficacy and safety of tacrolimus and low-dose of steroids in the treatment of steroid-resistant nephrotic syndrome in children.Methods21children with steroid-resistant nephrotic syndrome from October2008to July2010in this retrospective longitudinal study received oral tacrolimus treatment,0.1to0.15mg/kg per day and once every12hours, and prednisone0.2to0.75mg/kg per day simultaneously. During the treatment, regularly monitoring the plasma concentration of tacrolimus, urine volume, urine, serum creatinine and liver function were investigated.Results After1to3months treatment,14cases showed complete remission and7cases with partial remission.16patients received renal biopsy, of which6revealed minimal change nephropathy with complete remission in3cases,3cases with partial remission;4cases revealed focal segmental glomerulosclerosis with2complete remission and2partial remission; other5children with IgM nephropathy and1mesangial proliferative glomerulonephritis achieved complete remission. Within treatment period,6patients presented transient adverse reactions, without altering the principle treatment strategy, but only taking the symptomatic treatment. During follow-up,20cases were followed from2months to21months.4patients relapsed within1st-year follow-up, while at2nd-year follow-up, there were4cases (6times) of recurrence.Conclusion Tacrolimus showed a reliable effect in children with steroid-resistant nephrotic syndrome. Less adverse reactions can be seen, and most of them can be tolerated. Even these, children have a higher relapse rate after1to2years treatment. Therefore, the long-term effects of tacrolimus in steroid-resistant nephrotic syndrome remains to be further evaluated.