Efficacy And Safety Of Tacrolimus For The Treatment Of Pediatric Henoch-sch（?）nlein Purpura Nephritis

Background: Kidney damage is the main factor affecting the prognosis of Henoch–Sch（?）nlein purpura（HSP）.Children with severe Henoch–Sch（?）nlein purpura nephritis（HSPN）may progress to end-stage renal disease without appropriate treatment.This study aimed to investigate the efficacy and safety of tacrolimus combined with glucocorticoids in the treatment of pediatric HSPN.Methods: A total of 87 HSPN patients with urinary protein ≥0.75g/24 h received standard of care,including angiotensin II receptor blockers/angiotensin-converting enzyme inhibitors and glucocorticoids.Patients were divided into three groups and additionally received tacrolimus（n = 30）,cyclophosphamide（n = 31）,or mycophenolate mofetil（MMF）（n = 26）.We monitored outcome measures,including proteinuria,hematuria,and renal function and analyzed the efficacy and side effects in each group.Results: At 2-month follow-up,the overall efficacy was 93.3%,83.9%,and 61.5%for TAC,CTX,and MMF group,respectively（P < 0.05）.Urine protein significantly decreased for all groups.Urinary red blood cell counts significantly decreased for patients treated with TAC（P < 0.001）and CTX（P< 0.05）,whereas no significant decrease was seen for MMF group（P = 0.09）.Although urine β2‐microglobulin significantlydecreased following 2 months treatment with all medications,tacrolimus showed increased efficacy compared to CTX and MMF（P <0.001）.Major adverse events were respiratory and urinary infections with MMF having the highest infection rate.Moreover,CTXgroup showed additional adverse events including arrhythmia,hemorrhagic cystitis,leukocytosis,thrombocytopenia,and hyperglycemia.Conclusion:These results indicate that tacrolimus is more effective at reducing proteinuria and hematuria and improving renal function,with relatively milder side effects,in the treatment of pediatric HSPN.