Clinic Features And Prognosis Of Nephrotic Syndrome With AKI Associated With Tacrolimus

Objctive:To investigate the clinical features and prognosis of acute kidney injury (AKI) following tacrolimus (FK506) treatment in patients with nephrotic syndrome(NS).Methodology:From January 2010 to December 2014,72 NS patients were diagnosed AKI following FK506 treatment, and 206 NS patients as contrl group treated by FK506 with no AKI. Other causes of AKI were excluded, such as other drugs, infection, urinary obstruction and hypovolemia and so on. The clinical and prognosis of them were investigated.Results:There were 60 males and 12 females, with an average of (28.90±14.86) years old. The course of NS was 8 weeks (ranged frome 3.25 to 31.0). A total of 81 times of AKI were developed after (226.42±206.12) days following FK506 treatment. The primary glomerular disease of NS includes podocytopathy (27.78%), FSGS (40.28%) and MN (31.94%). The urine volume, proportion of hypertension, BUN, serum creatinine, triglyceride and CystatinC were significantly differed between two groups before FK506 treatment. The urine level of protein, RBP, NAG and glucose was also markedly differed. Diuretics were more frequently prescribed in AKI group. FK506 treatment was less effective in AKI group within 3 month. After AKI, fasting blood-glucose, urine level of RBP, glucose and urine volume were statistically different when compared with before. Multiple logistic regressive anaylsis suggested that the occurrence of AKI was associated with the quantity of proteinuria, CystatinC, proportion of glycosuria before FK506 treatment, inefficacy of FK506 treatment within 3 month and the use of diuretic. Withdrawal or reduction the dose of FK506 could promote the recovery of serum creatinine. Kaplan-Meier survival analysis revealed a significant difference in the long-term outcome between the two groups. Multiariable COX regression analysis suggested that inefficacy of FK506 within 3 month and time-average proteinuria during follow-up were the independent risk factors of poor prognosis in AKI associated with FK506 in NS patients.Conclusion:There was risk of AKI for treatment of FK506 in NS patients. Withdrawal or dose reduction of FK506 can promote the short-term outcome of renal function, but some patients may suffer a poor long-term prognosis.