PDF(1488 KB)
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
Chinese Journal of Contemporary Pediatrics ›› 2019, Vol. 21 ›› Issue (3) : 265-270.
PDF(1488 KB)
PDF(1488 KB)
Clinical effect of tacrolimus combined with glucocorticoid in the treatment of IgA nephropathy in children
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.
IgA nephropathy / Tacrolimus / Mycophenolate mofetil / Child
[1] 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.
[2] 中华医学会儿科学分会肾脏学组. 原发性IgA肾病诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(9):643-646.
[3] 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.
[5] 沈平雁, 贾晓媛, 王朝晖, 等. 他克莫司治疗原发性IgA肾病伴轻中度肾功能损伤的随机对照临床研究[J]. 中华肾脏病杂志, 2014, 30(12):885-890.
[6] 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.
[15] 王琴, 张建江, 窦文杰, 等. 霉酚酸酯治疗IgA肾病疗效与安全性的系统评价[J]. 中华肾脏病杂志, 2018, 34(12):900-908.
[16] 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.
[22] 杨仪赫, 吕继成, 张宏. 新月体性IgA肾病的临床研究进展[J]. 中华肾脏病杂志, 2012, 28(12):977-980.
[23] 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.
