Clinical Observation And Long-term Follow-up Of Prolonged Tacrolimus In The Treatment Of Idiopathic Membranous Nephropathy

Background:Idiopathic membranous nephropathy(IMN)is the most common cause of nephrotic syndrome(NS)in adults, and about40% of IMN patients eventually develop end-stage renal failure( ESRD).There is no uniform treatment 。 The effect of conservative treatment is limited, and the glucocorticoid and cyclophosphamide which is common immune suppression scheme has severe side effects。Tacrolimus(TAC) as alternative scheme,although it has satisfactory efficacy and safety, high recurrence rate after withdrawal should pay much attention。Therefore, the rational use of TAC, which is of great significance in reducing the recurrence rate in patients with IMN.Objective: To compare the efficacy and safety of different terms of treatment TAC to patients with nephrotic syndrome caused by IMN; To follow up the patients with prolonged tacrolimus treatment of remission rate, recurrence rate and long-term adverse reaction.Method:A total of 25 patients with nephrotic syndrome caused by IMN were enrolled from January 2008 through December in the Department of Nephrology of the Second Hospital of Jilin University,and were randomly divided into a short-term(12cases) and a long-term(13 cases)groups。All patients received initial treatment with tacrolimus and prednisone for 12 months,and afterward only the long-term patient group was tapered with low-dose tacrolimus until 24 months.Long-term patients were followed up one times a year until 2015 after the completion of tacrolimus treatment。Results: 1.About 84% of the patients achieved protein-uria reduction、 serum albumin increasing. 2.At the beginning of the treatment in the 12 th month,the total remission rate was 84%,and the difference between the two groups was no significant(P > 0.05).In the 18 th and 24 th months,the remission rate of long-term group was stable at 84.6%,but the remission rate of short-term group was only 66.7% and 58.3%,respectively,and the difference between the two groups has statistical significance(P < 0.05).There was not a single patient suffered recurrence in long-term group and 3 patients relapsed after tacrolimus withdrawal in short-term group。3.5 patients with long-term follow-up did not relapse and have light adverse reaction,after 5 years of the tacrolimus treatment。Conclusion:1.TAC combined with small dose of prednisone can effectively relieve the clinical symptoms of IMN patients with NS;2.Prolonged term of treatment and using small doses of TAC to maintain treatment can keep the low recurrence rate and have the light adverse reaction in the time of TAC withdrawal or long-term follow-up;3.During the reduction of TAC,we should adjust to the doses of TAC according to the conditions avoiding the recurrent of disease;4.Repeatedly using TAC treatment is still valid after relapsed in TAC withdrawal, and the continuous use did not appear the resistance;5.For the patients with partial remission,especially having complete remission in the treatment process, through the appropriate extension of medication course might achieve complete remission。...