Tacrolimus Combined With Low-dose Prednisone In Treatment Of Nephrotic Idiopathic Membranous Nephropathy

Objective:The purpose of the study is to evaluate the efficacy and safety of tacrolimus combined with low-dose corticosteroids in treatment of nephrotic idiopathic membranous nephropathy in comparison with the protocol of CTX combined with low-dose corticosteroids.Methods:33patients with nephrotic IMN were included in the study,21patients receiving tacrolimus, started with a dose of0.05mg/kg/d, divided into2daily doses. The doses of tacrolimus were adjusted according to the blood trough level. Others receiving transvenous CTX, at a dose of750mg/m2monthly, the accumulative dose of CTX was6-10g. Patients of both groups were given prednisone0.5mg/kg/d initially, and tapered gradually to discontinued. The patients were followed for12months, then observe treatment effects, recurrence and side effects in2groups.Results:33patients met criteria for enrollment, and32patients completed therapy. One patient discontinued CTX therapy due to granulocytopenia. At the end of the6th month, remission was observed in7patients (58.3%) in CTX group, and17patients (78.6%) in tacrolimus group. At the end of the12th month, remission was observed in8patients (66.7%) in CTX group, and15patients (71.4%) in tacrolimus group. Proteinuria was significantly decreased after treatment in both groups. Serum albumin was significantly increased in both groups after treatment. Serum creatinine and estimated glomerular filtration rate were comparable between before and after treatment.Conclusions:Tcrolimus combined with low-dose steroids is an alternative therapeutic regimen for patients with nephritic IMN. Its short-term efficacy might be better the CTX.