Clinical Effects Of Tacrolimus Division Combined With Glucocorticoids On The Treatment Of Idiopathic Membranous Nephropathy

Objective: To evaluate the efficacy and safety of tacrolimus combined withglucocorticoid hormone in treatment of idiopathic membranous nephropathy (idiopathicmembranous nephropathy, IMN),using a single-center clinical, randomized, controlledand prospective study.Methods: A prospective study was conducted for61cases of patients with IMNdiagnosed by the renal biopsy pathological between January2008and December2010.Using a randomized controlled method was divided into two groups (A and B).33patients(A group) were given tacrolimus combined with glucocorticoid treatment.Tacrolimus started with a dose of0.05mg/kg/d, divided into2daily doses, according toblood drug concentration to adjust the drug doses. Others(B group) was givenCyclophosphamide (CTX) combined with glucocorticoid treatment. CTX started with adose of1000mg/m2,1once a month, for six consecutive months. Those patients whohad no effects after6-month treaments stopped the doses.the accumulative dose of CTXwas less than10g. Patients of both groups were given prednisone1mg/(kg·d)initially,and8weeks after reduction, decreasing5mg every2weeks, when reduced to30mg/d,decreasing2.5mg biweekly from10mgd to10mg/d, then retaining dose of10mg/d.24hours after treatments,we started to observe their effects,recurrence and side effects in2groups.Results: During the experiment, One patient with deterioration of renal function ingroup A and one patient with bone marrow suppression in group B were withdrewedfrom the study,59patients were completed therapy. The patients’ s gender, age, urineprotein, serum albumin, serum creatinine, eGFR had no significant difference (P>0.05)in two groups. Kidney pathological evaluation included the electron microscope,puncture glomerular number, glomerular sclerosis, segmental sclerosis, crescents andvascular lesions had no significant difference (P>0.05). During the follow-up period, Glomerular filtration rate, serum creatinine, blood sugar, white blood cells, cereal thirdtransaminase fluctuation had no significance difference (P>0.05) in both groups.At theend of the6th month,remission was observed in28patients(84.4%) in group A,and19patients(66.7%) in group B, had no significant difference (P>0.05).,But compared withgroup B,the patients’s24-hour urine protein quantitative fell to(1.26±0.86)g from(9.04±3.56)g (p <0.05), serum albumin level from (21.25士3.76)g/Lto (42.98±5.99)g/L(p <0.05), the difference was statistically significant.At the end of the12thmonth,remission was observed in26patients(78.1%) in group A,and20patients(70.4%)in group B, had no significant difference (P>0.05), Two groups’s24hours urineprotein and serum albumin levels had no significant difference (p>0.05).Proteinuriawas significantly decreased after treatment in both groups.Serum albumin wassignificantly increased after treatment.Conclusion: Tacrolimus combined with glucocorticoids is an alternativetherapeutic regimen for patients with nephritic IMN, It has better short-termefficacy than CTX.