The efficacy and safety of tacrolimus in treating refractory IgA vasculitis nephritis: a single-center retrospective study on 16 cases

作者全名：Gan, Yueheng; Chen, Jiahuan; Wang, Mo; Li, Qiu; Wang, Anshuo; Yang, Haiping

作者地址：[Gan, Yueheng; Chen, Jiahuan; Wang, Mo; Li, Qiu; Wang, Anshuo; Yang, Haiping] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Nephrol, Childrens Hosp,Minist Educ,Key Lab Child Dev & Dis, Chongqing, Peoples R China

通信作者：Wang, AS; Yang, HP (通讯作者)，Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Nephrol, Childrens Hosp,Minist Educ,Key Lab Child Dev & Dis, Chongqing, Peoples R China.

来源：CLINICAL KIDNEY JOURNAL

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001220119500001

JCR分区：Q1

影响因子：3.9

年份：2024

卷号：17

期号：5

开始页：　

结束页：　

文献类型：Article

关键词：children; IgA vasculitis with nephritis; proteinuria; tacrolimus

摘要：Background. This study aimed to observe the efficacy and safety of tacrolimus in the treatment of refractory immunoglobulin A vasculitis nephritis (IgAVN). Methods. Sixteen patients with IgAVN who had been previously treated with cyclophosphamide shock therapy at least five times, some of whom had also received mycophenolate but still had persistent proteinuria, were enrolled. The clinical and pathological data were collected and analysed. Results. The average (mean +/- standard deviation) age at the initial assessment for the group of 16 patients was 10 +/- 2.7 years. Finally, at the end of their respective follow-up time point, 6 of the 16 patients achieved complete remission (37.5%), 5 achieved partial remission (31.2%), and 5 had no remission (31.2%). A significant difference was found in the median proteinuria before and after a 6-month course of tacrolimus treatment [19.2 (11.2, 31.9) vs 7.8 (4.3, 13.9) mg/kg/day] (P < .05). During the first 6 months of tacrolimus treatment, all patients' estimated glomerular filtration rate levels remained normal. The mean tacrolimus blood concentration was 6.0 +/- 2.6 ng/mL. The median prednisone dosage was decreased from 10 mg/day to 5 mg/day, and prednisone was eventually stopped in three individuals. No drug-related adverse effects were observed during treatment. Conclusions. Tacrolimus has demonstrated efficacy in increasing remission rates, significantly lowering urinary protein levels, and reducing steroid use in children with refractory IgAVN. Further research is required to investigate its optimal blood concentrations, long-term effects and renoprotective properties.

基金机构：National Key R&D Program of China [2022YFC2705101]; Chongqing Science and Health Joint Medical Research Project [2023GGXM001]; Program for Youth Innovation in Future Medicine, and Chongqing Medical University [W0098]

基金资助正文：We thank the National Key R&D Program of China (no.2022YFC2705101), Chongqing Science and Health Joint Medical Research Project (grant no.2023GGXM001), Program for Youth Innovation in Future Medicine, and Chongqing Medical University(no.W0098)