The Efficacy Of Prednisolone Plus Tacrolimus For The Treatment In Children With Steroid-resistant Nephrotic Syndrome

Objectives:Primary nephrotic syndrome(PNS)is a common glomerular disease in childhood.On the basis of PNS patients’ response to glueocorticosteroid therapy,PNS is divided into steroid-sensitive nephrotic syndrome(SSNS)and steroid-resistant nephrotic syndrome(SRNS).SRNS is divided into initial non-respond and late non-respond.The aim of this study is to analyze the efficacy of glucocorticoid combined with tacrolimus in the treatment of SRNS in children.Methods:Forty-four children diagnosed as SRNS were recruited into our study at Department of Pediatrics of Fuzhou General Hospital from January 2010 to November 2017.We had a retrospective analysis about their clinical data.Measurement data was expressed with averages,and counting data was expressed with percentage.P<0.05 was considered statistically significant.Results:Forty-four children were diagnosed as SRNS(16 boys and 14 girls).After 6 months treatment of prednisolone plus tacrolimus,15 of 16 initial non-respond patients(93.8%)showed complete remission,and their remission time was ranged from 3 to 86 days.After 6 months of follow-up,nephrotic syndrome(NS)relapse rate was 56.3%(9/16).After 1 year of follow-up,NS relapse rate was 68.8%(11/16).During the treatment of tacrolimus,one patient whose alanine aminotransferase was 114 U/L and aspartate amino transferase 83 U/L recovered normal level,and 2 patients developed nausea and vomiting symptoms and were relieved with symptomatic treatment.After 6 months treatment of prednisolone plus tacrolimus,27 of 28 late non-respond(96.4%)showed complete remission,and their remission time was ranged from 13 to 137 days.After 6 months of follow-up,nephrotic syndrome(NS)relapse rate was 53.6%(9/16).After 1 year of follow-up,NS relapse rate was 60.7%(17/28).During the treatment of tacrolimus,one patient whose alanine aminotransferase was 108 U/L and aspartate amino transferase 74 U/L recovered normal level,and 1 patient developed nausea and vomiting symptoms and were relieved with symptomatic treatment.Conclusion:After 6 months of treatment with prednisolone plus tacrolimus,complete remission rate was 95.5%in children with SRNS,and the incidence of tacrolimus adverse reactions was 15.9%.These results suggest that the treatment with prednisolone plus tacrolimus should be recommended for the children with SRNS.