Efficacy and safety of tacrolimus in the treatment of IgA nephropathy
SU Xiao-le1，2, SHI Su-fang1*, LIU Li-jun1, CHEN Yu-qing1, LV Ji-cheng1, ZHANG Hong1,
1 Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease,Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China; 2 Department of Nephrology, the Secondary Hospital, Shanxi Medical University, Shanxi Kidney Disease Institute, Taiyuan 030001, China）
Abstract：Objective: To investigate the clinical efficacy and adverse reaction of tacrolimus in the treatment of IgA nephropathy. Methods: Biopsy-proven IgA nephropathy patients who had been treated with tacrolimus and with follow-up time more than 1-year in Renal Division Peking University First Hospital, were enrolled in this retrospective study. Urinary protein excretion, serum albumin levels, glomerular filtration rate (eGFR),and tacrolimus related adverse events during the treatment and follow-up were evaluated. Results: A total of 21 patients with mean age (29.4 ± 10.6) years were analyzed. The mean follow-up time was (54.0 ± 35.8) months. All patients had been treated with ACEI/ARB and/or immunosuppressive therapy before tacrolimus therapy, and their urinary protein excretion were still more than 1g·d-1. Before tacrolimus therapy, the mean urinary protein excretion was (4.84±2.40) g·d-1 and mean eGFR was (78.33±37.30) mL·min-1·1.73 m-2. 5/21 patients with mean eGFR (34.70±9.67) mL·min-1·1.73 m-2 withdrew tacrolimus treatment within 1~1.5 months, because of more than 15% of eGFR decline. For 16 patients who were treated with tacrolimus more than 6 months, 13/16 cases (81.3%) achieved proteinuria remission, including 12 cases of complete remission and 1 case of partial remission. Mean times to achieve remission were (5.31±3.35) weeks. 8/13 cases achieved remission in 4 weeks. The level of eGFR before and after tacrolimus treatment withdrawal didn’t change significantly in 16 cases (93.5±32.8) vs (80.4±32.5) mL·min-1·1.73 m-2, P = 0.27). In patients who achieved complete or partial remission, 46.2% experienced relapse during follow-up. Other adverse events included infection (2 cases), new-onset hypertension (1 case) and hyperuricemia (3 cases).Conclusion: ① Tacrolimus showed a rapid proteinuria remission in IgAN patients with ACEI/ARB and/or hormone immunosuppressive therapy resistance, but it should be used cautiously in patients with CKD stage 3. ② There was a high relapse rate during tapering or cessation of tacrolimus therapy.
苏晓乐，师素芳，刘立军，陈育青，吕继成，张宏. 他克莫司治疗IgA肾病的疗效及安全性的观察研究[J]. 临床药物治疗杂志, 2015, 13(1): 18-24.
SU Xiao-le, SHI Su-fang, LIU Li-jun, CHEN Yu-qing, LV Ji-cheng, ZHANG Hong. Efficacy and safety of tacrolimus in the treatment of IgA nephropathy. CLINICAL MEDICATION JOURNAL, 2015, 13(1): 18-24.
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2015, Vol. 13 
