Tacrolimus therapy in adults with steroid- and cyclophosphamide-resistant nephrotic syndrome and normal or mildly reduced GFR
zn0486 添加于 2010-5-6 16:58
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作 者
Li X, Li H, Ye H, Li Q, He X, Zhang X, Chen Y, Han F, He Q, Wang H, Chen J 摘 要
BACKGROUND: In a proportion of adults with steroid-resistant nephrotic syndrome (SRNS), intravenous cyclophosphamide therapy fails. Tacrolimus may be a promising alternative to cyclophosphamide for such patients. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: 19 adults with SRNS (6 with minimal change nephropathy, 8 with focal segmental glomerulosclerosis [FSGS], and 5 with mesangioproliferative glomerulonephritis) that did not respond to intravenous cyclophosphamide therapy were studied from January 2003 to September 2006. Oral tacrolimus was administered (target trough levels, 5 to 10 ng/mL) for 24 weeks, then reduced doses were given (target trough level, 3 to 6 ng/mL) for another 24 weeks. FACTORS: Histopathologic types: minimal change nephropathy (n = 6), FSGS (n = 8), and mesangioproliferative glomerulonephritis (n = 5). OUTCOMES: Measurements: outcome variables included complete remission (decrease in daily proteinuria to protein < or = 0.3 g/d), partial remission (decrease in daily proteinuria to protein < 3.5 g/d but > 0.3 g/d), relapse (increase in daily proteinuria to protein > or = 3.5 g/d in patients who had partial or complete remission), change in kidney function, and tacrolimus dosing and serum levels. RESULTS: 17 patients completed at least 24 weeks of tacrolimus therapy. Complete remission was achieved in 11 patients (64.7%), and partial remission was achieved in 3 (17.6%). Complete or partial remission was achieved in 5 of 5 patients with minimal change nephropathy, 4 of 7 patients with FSGS, and 5 of 5 patients with mesangioproliferative glomerulonephritis. Primary resistance to tacrolimus was seen in 3 patients (17.6%), all with FSGS. Mean times to achieve partial and complete remission were 5.6 +/- 1.4 and 8.0 +/- 5.1 weeks, respectively. In patients who achieved complete or partial remission, 35.7% experienced relapse during follow-up (mean, 37.6 +/- 13.4 months). Two patients had doubling of serum creatinine levels, both with FSGS. LIMITATIONS: Observational study. CONCLUSIONS: Tacrolimus rapidly and effectively induced remission of SRNS in Chinese adults with disease refractory to treatment with intravenous cyclophosphamide. Treatment may be less effective in patients with FSGS.-
详细资料
- 关键词: Administration, Oral; Adolescent; Adult; China; Creatinine/blood; Cyclophosphamide/administration & dosage/*therapeutic use; *Drug Resistance; Female; Follow-Up Studies; Glomerular Filtration Rate/drug effects/*physiology; Glomerulonephritis, Membranoproliferative/blood/drug therapy/physiopathology; Glomerulosclerosis, Focal Segmental/blood/drug therapy/physiopathology; Humans; Immunosuppressive Agents/administration & dosage/pharmacology/*therapeutic use; Injections, Intravenous; Male;
- 文献种类:期刊
- 期刊名称: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
- 期刊缩写: Am J Kidney Dis
- 期卷页: 2009年 第54卷 第1期 51-58页
- 地址: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
- ISBN: 0272-6386
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