Clinical effect of tacrolimus combined with glucocorticoid in the treatment of IgA nephropathy in children
ZHANG Jian-Jiang, WANG Qin, DOU Wen-Jie, JIA Li-Min, ZHANG Li, CHENG Yi-Bo, TAN Wen-Xiu, ZHAO Fan
Department of Pediatrics, First Affliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou 450052, China
Abstract：Objective To study the clinical effect and safety of tacrolimus (TAC) combined with glucocorticoid (GC) versus mycophenolate mofetil (MMF) combined with GC in the treatment of primary IgA nephropathy (IgAN) in children. Methods A retrospective analysis was performed for the clinical data of children with primary IgAN confrmed by renal pathology between January 2012 and December 2017. These children were divided into TAC group and MMF group according to the treatment regimen. Their clinical data before treatment and at 1, 3, and 6 months of treatment were collected, and the remission status of IgAN and adverse reactions were compared between the two groups. Results A total of 43 children who met the inclusion criteria were enrolled, with 15 children in the TAC group and 28 children in the MMF group. At 1 month of treatment, there was no signifcant difference in the remission status between the two groups (P > 0.05). At 3 and 6 months of treatment, the TAC group had a signifcantly better remission status than the MMF group (P < 0.05). At 1 month of treatment, the TAC group had higher serum albumin levels than the MMF group (P < 0.05). Both groups had a signifcant increase in serum albumin levels at each time point after treatment (P < 0.0083) and a signifcant increase in the glomerular fltration rate (GFR) at 3 and 6 months of treatment (P < 0.0083). There was no signifcant difference in the overall incidence rate of adverse reactions between the two groups (P > 0.05), but fungal infection was observed in one child from the TAC group. Conclusions TAC combined with GC can effectively reduce urinary protein in children with primary IgAN, and it has a better short-term clinical effect than MMF combined with GC, with good safety.
ZHANG Jian-Jiang,WANG Qin,DOU Wen-Jie et al. Clinical effect of tacrolimus combined with glucocorticoid in the treatment of IgA nephropathy in children[J]. CJCP, 2019, 21(3): 265-270.
Penfold RS, Prendecki M, Mcadoo S, et al. Primary IgA nephropathy:current challenges and future prospects[J]. Int J Nephrol Renovasc Dis, 2018, 11:137-148.
Yang EM, Lee ST, Choi HJ, et al. Tacrolimus for children with refractory nephrotic syndrome:a one-year prospective, multicenter, and open-label study of Tacrobell®, a generic formula[J]. World J Pediatr, 2016, 12(1):60-65.
[4]
He L, Peng Y, Liu H, et al. Treatment of idiopathic membranous nephropathy with combination of low-dose tacrolimus and corticosteroids[J]. J Nephrol, 2013, 26(3):564-571.
Zhang Y, Luo J, Hu B, et al. Effcacy and safety of tacrolimus combined with glucocorticoid treatment for IgA nephropathy:a meta-analysis[J]. J Int Med Res, 2018, 46(8):3236-3250.
[7]
Zheng JN, Bi TD, Zhu LB, et al. Efficacy and safety of mycophenolate mofetil for IgA nephropathy:an updated metaanalysis of randomized controlled trials[J]. Exp Ther Med, 2018, 16(3):1882-1890.
[8]
Trimarchi H, Barratt J, Cattran DC, et al. Oxford Classifcation of IgA nephropathy 2016:an update from the IgA Nephropathy Classifcation Working Group[J]. Kidney Int, 2017, 91(5):1014-1021.
[9]
Lee HS, Lee MS, Lee SM, et al. Histological grading of IgA nephropathy predicting renal outcome:revisiting H. S. Lee's glomerular grading system[J]. Nephrol Dial Transplant, 2005, 20(2):342-348.
[10]
Berger J, Hinglais N. Intercapillary deposits of IgA-IgG[J]. J Urol Nephrol (Paris), 1968, 74(9):694-695.
[11]
Yeo SC, Cheung CK, Barratt J. New insights into the pathogenesis of IgA nephropathy[J]. Pediatr Nephrol, 2018, 33(5):763-777.
[12]
Zhao YF, Zhu L, Liu LJ, et al. Measures of urinary protein and albumin in the prediction of progression of IgA nephropathy[J]. Clin J Am Soc Nephrol, 2016, 11(6):947-955.
[13]
Floege J, Eitner F. Current therapy for IgA nephropathy[J]. J Am Soc Nephrol, 2011, 22(10):1785-1794.
[14]
Liu X, Dewei D, Sun S, et al. Treatment of severe IgA nephropathy:mycophenolate mofetil/prednisone compared to cyclophosphamide/prednisone[J]. Int J Clin Pharmacol Ther, 2014, 52(2):95-102.
Li CJ, Li L. Tacrolimus in preventing transplant rejection in Chinese patients——optimizing use[J]. Drug Des Devel Ther, 2015, 9:473-485.
[17]
Chen W, Liu Q, Liao Y, et al. Outcomes of tacrolimus therapy in adults with refractory membranous nephrotic syndrome:a prospective, multicenter clinical trial[J]. Am J Med Sci, 2013, 345(2):81-87.
[18]
Supavekin S, Surapaitoolkorn W, Kurupong T, et al. Tacrolimus in steroid resistant and steroid dependent childhood nephrotic syndrome[J]. J Med Assoc Thai, 2013, 96(1):33-40.
[19]
Loeffler K, Gowrishankar M, Yiu V. Tacrolimus therapy in pediatric patients with treatment-resistant nephrotic syndrome[J]. Pediatr Nephrol, 2004, 19(3):281-287.
[20]
Hu T, Liu Q, Xu Q, et al. Tacrolimus decreases proteinuria in patients with refractory IgA nephropathy[J]. Medicine (Baltimore), 2018, 97(18):e0610.
[21]
Zhang Q, Shi SF, Zhu L, et al. Tacrolimus improves the proteinuria remission in patients with refractory IgA nephropathy[J]. Am J Nephrol, 2012, 35(4):312-320.
Scalea JR, Levi ST, Ally W, et al. Tacrolimus for the prevention and treatment of rejection of solid organ transplants[J]. Expert Rev Clin Immunol, 2016, 12(3):333-342.
