Efficacy Of FK506/MMF Combined With Low Dose Prednisone In The Treatment Of IgA Nephropathy(IgAN)

Background and purposeIgA nephropathy is a kind of glomerular disease that IgA based immune complex deposition in glomerular mesangial region,is one of the most common primary glomerular disease,According to the statistics of IgA nephropathy,renal survival rate was 85.1% in 5 year,77.1% in 10 years,more than 30% patients progression to end-stage renal disease(ESRD),it is the first primary disease of China's chronic kidney disease progression to hemodialysis.IgA nephropathy patients often show different degrees of proteinuria,hematuria,At present,proteinuria is one of the major risk factors of that affecting the long-term prognosis of IgA nephropathy [1-2],and that the 24 hour urinary protein below 1.0g/d can significantly reduce the risk of patients progress to ESRD [3].IgA nephropathy's treatment is usually ACEI / ARB,the hormone and / or immunosuppressive agents,immunosuppressive agents common with cyclosporine A cyclophosphamide and tacrolimus(FK506),mycophenolate mofetil(MMF),leflunomide,FK506 and MMF are regarded as the most common immunosuppressive agents for the treatment of IgA nephropathy.This study on curative effect of prednisone combined with FK506 or MMF in the treatment of idiopathic IgA nephropathy was observed in small doses,and compared the effect of treatment two groups to provide evidence and reference for new immunosuppressant IgA nephropathy's treatment options,so as to reduce the risk of relapse and progression of nephropathy in renal function to improve the prognosis of IgA nephropathy.MethodSelect a total of 75 patients from June 2012 to July 2017 that were in the 1st Affiliated Hospital of ZZU Department of Nephrology hospital admission,and the clinical manifestations of moderate proteinuria(1 ~ 3.5 g/24 h),normal renal function and Ig A nephropathy diagnosed by renal biopsy.According to the treatment,the patients were divided into group(36 cases)named prednisone +FK506 and group(39 cases)named prednisone +MMF.Prednisone treatment starting dose of 0.5 mg/(kg-D)(maximum dose of not more than 40 mg/d),FK506 treatment was 0.05 ~ 0.08 mg/(kg-D),the minimum concentration of 4 ~ 8ng/mL,MMF dosage of 0.5g BID treatment,prednisone reduced 10%-15% the original dose of every 3~4 weeks,selected 24 hours urine protein,human serum albumin(Alb),serum creatinine(Scr)level as the main clinical evaluation index,serum uric acid(UA)level,serum glucose level(Glu),whether associated with gastrointestinal symptoms and infection or not are used as an indicator of adverse reactions.Result1.After 3 months of treatment,the quantitative urine protein decreased significantly in 24 hours,and the Alb increased significantly in the two groups.The difference was statistically significant(P<0.05).2.The changes of Scr,UA and Glu as well as the difference of infection and digestive tract symptoms in the two groups were not statistically significant before and after treatment(P>0.05).3.Compared with prednisone combined with group MMF,the rate of complete remission of renal disease in prednisone combined with FK506 group was statistically significant(P<0.05).ConclusionIn the treatment of moderate proteinuria in patients with IgA nephropathy,prednisone combined with FK506 and prednisone combined with MMF have achieved good therapeutic effects.At the same time,prednisone combined with FK506 showed a better effect on reducing proteinuria than MMF combined with MMF,and brought about a higher clinical remission rate.