Tacrolimus Monotherapy In Treatment Of Nephrotic Idiopathic Membranous Nephropathy

Objective:The purpose of the study is to evaluate the efficiency and safety of tacrolimus monotherapy in treatment of nephrotic idiopathic membranous nephropathy in comparison with the protocol of CTX combined with low-dose corticosteroids and tacrolimus combined with low-dose corticosteroids.Methods:36patients with nephrotic syndrome and biopsy proved IMN were included in this study.7patients received tacrolimus monotherapy with the initial dose of0.05mg/kg.d,19patients received tacrolimus (initial dose of0.05mg/kg.d)combined with corticosteroids(prednisone0.5mg/kg/d initially),11patients received transvenous CTX, at a dose of800-1200mg/m2every other week for the first8weeks, and monthly for the later period, the accumulative dose of CTX was150mg/kg,and combined with corticosteroids(prednisone0.5mg/kg/d initially). Both tacrolimus and corticosteroids were tapperd gradually to discontinued. The patients were followed for at least12weeks, observe treatment effects, recurrence and side effects.Results:36patients met criteria for enrollment. At the end of the12th week, remission was observed in4patients(57.1%) in TAC monotherapy group, llpatients(57.8%) in TAC combined with corticosteroids group, and7patients(70%) in CTX group. At the end of the24th week, remission was observed in3patients(60%) in TAC monotherapy group,12patients(85.7%) in TAC combined with corticosteroids group, and4patients in CTX group. The remmision rates among the3groups are similar. Proteinuria(counted with uPCR) was significantly decreased after treatment in all3groups, and albumin was significantly increased in all groups. Serum creatine(SCr), eGFR(estimated glomerular filtration rate), ALT and TB were comparable between before and after treatment.Conclusions:Tacrolimus monotherapy is an alternative therapeutic regimen for patients with nephritic IMN. Its short-term efficiency and the patients’ tolerance are both fine.