Clinical Observation Of The Tacrolimus Therapy In30Cases Of Membranous Nephropathy

Background and ObjectivesMembranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. The etiology and pathogenesis of the transformation are poorly understood, and most of the observations are hypothetical. Recently, M-type phospholipase A2receptor (PLA2-R) has been discovered as the main podocyte antigen in the pathogenesis of idiopathic MN. It has a very variable clinical course with all possible outcomes, ranging from spontaneous remission to progressive deterioration and development of end-stage renal disease (ESRD). Membranous nephropathy is refractory nephrotic syndrome, no recognized treatment plan, the treatment is immunosuppressive therapy. The hormone combined with immunosuppressant treatment options exist many deficiencies, many patients can not tolerate the adverse reactions had to give up treatment. Tacrolimus as a new immunosuppressive agents was reported in the literature for the treatment of idiopathic membranous nephropathy. This study evaluated the efficacy and safety of tacrolimus plus prednisone in membranous nephropathy manifested with nephrotic syndrome, which provide a experimental basis for the clinical treatment of idiopathic membranous nephropathy.Methods Thirty patients diagnosed with membranous nephropathy by renal biopsy between March2004and December2012in the Second Affiliated Hospital of Zhengzhou University were randomly divided into two groups, with15cases in each group. The treatment group was received tacrolimus(0.05mg/kg/d) plus prednisolone(0.5mg/kg/d), the control group was given leflunomide(20mg/d) combined with prednisolone(0.5mg/kg/d). Albumin, blood glucose,24-hour urine protein quantification, cholesterol, triglycerides, serum creatinine were determined before and after treatment for2,4,8,12,24weeks.ResultAfter treatment for24weeks, compared with control group, tacrolimus combined with prednisolone increased the total effective rate(80.0%V53.3%), decreased24-hour urinary protein excretion and triglyceride (P<0.05), and raised serum Alb level (P<0.05). No obvious changes in levels of serum creatinine and blood sugar were observed after treatment for2,4,8,12,24weeks in both groups(P>0.05).ConclusionsCompared with combined treatment with Leflunomide and prednisolone, tacrolimus combined prednisolone can alleviate disease condition, enhance safety and reduce the risk of deterioration of renal function in membranous nephropathy.