| Objective : To compare the efficacy and safety of tacrolimus monotherapy and tacrolimus combined with glucocorticoids therapy in idiopathic membranous nephropathy.Methods:Clinical data were retrospectively analyzed in twenty-six nephritic syndrome patients who diagnosed IMN by renal biopsy and were treated with tacrolimus for at least six months in the Department of Nephrology of the First Affiliated Hospital of Fujian Medical University from September 2011 to September 2014. According to the different therapy,all of the included IMN patients were divided into the tacrolimus monotherapy group(group A) and the tacrolimus combined with glucocorticoids therapy group(group B).Patients of group A were given tacrolimus treatment started with a dose of 0.05mg/kg/d. The dose of tacrolimus were adjusted according to the trough blood concentration in order to achieve the target blood concentration of 4~8ng/m L.After 6-month treatment,for patients who achieved remission,the dose of tacrolimus was tapered.Patients of group B received the same tacrolimus treatment protocol as group A,but with a concomitant of oral prednisone 0.5~1.0mg/kg/d or methylprednisolone 0.4~0.8mg/kg/d initially. Prednisone was tapered gradually after two months until reaching a daily dose of 10mg/d. Methylprednisolone was tapered gradually until reaching a daily dose of 8mg/d.The change of the 24-hour urine protein quantification, serum albumin,serum creatinine, serum uric acid, fasting blood glucose,hepatic function before and after treatment for 6 months was observed,and the side effects after treatment were recorded.Results:1.A total number of 26 patients were included in the study,12 patients in group A while 14 patients in group B. The gender,age,pathological stages and 24-hour urine protein quantification, serum albumin,kidney function,fasting,blood lipid,blood glucose,hepatic function and combined treatment of patients in the two groups had no significant difference(P﹥0.05). 2.The remission rate was 83% in group A,and 86% in group B. The complete remission rate was 25% in group A,and 29% in group B.Both the complete remission rate and remission rate between two groups had no significant difference(P﹥0.05). 3.After treatment,24-hour urine protein quantification was significantly decreased and the serum albumin was significantly increased in both group compared with that before treatment.There is no significant difference between group A and group B(P﹤0.05). 4. During 6-months treatment,the serum creatinine levels and e GFR remained stable in both group,and their difference is of no significance between two groups(P﹥0.05).No obvious nephrotoxicity was found in the study. 5. At the end of the 6th month,The change of serum uric acid, fasting blood glucose,hepatic function compared with those before treatment had no significant difference(P﹥0.05). 6.The side effects observed in the study included high blood glucose,hyperuricemia,infection and transient hepatic dysfunction. The incidence rate of side effects in group A was significantly lower than that in group B(P﹤0.05). All of the side effects occurred in group A were mild and transitory.Conclusions:1.Tacrolimus monotherapy may be an alternative therapeutic regimen for idiopathic membranous nephropathy patients.After treatment,the serum albumin was significantly increased and 24-hour urine protein quantification was significantly decreased. It’s efficacy may be equal to the tacrolimus combined with glucocorticoids therapy in short term. 2. The tacrolimus monotherapy may be as effective as the tacrolimus combined with glucocorticoids therapy in preserving renal function in short term.3.Compared with tacrolimus combined with glucocorticoids therapy,the tacrolimus monotherapy shows better safety because of its lower incidence rate of adverse reactions. |
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