Tacrolimus efficacy in steroids resistant nephrotic syndrome patients

Abstract

The progression of nephrotic proteinuria can to evolve towards the chronic renal insufficiency. To the patients with steroids resistant nephrotic syndrome we have used the tacrolimus Objective: To evaluate the use of tacrolimus to reduce the proteinuria below the nephrotic range. Methods: 7 patients received tacrolimus, mean of age 14 years. Inclusion criterios: Primary nephrotic syndrome with focal and segmental glomerulosclerosis, resistant to corticoids, Ciclofosfamida and Cyclosporine. All with normal glomerular filtrate rate and normotension. Exclusion criterion: Diabetes, leukopenia. Suspension criterion: Increase of creatininemia > 20% of initial value, hyperglycemia in 3 successive controls during 3 days continuous, leukopenia, active infection. The response was considered as a reduction in the urinary protein excretion lower than 40 mg/m2/hour. The time of administration of tacrolimus for the respondent patients was of 12 months and the last control of laboratory was at the 15 months. Results: 6 patients with a percentage of reduction of proteinuria of 26%, the mean dose of tacrolimus was of 0, 23 mg/kg/day and dosage was of 14 ng/ml. In no case was necessary to suspend the tacrolimus during the treatment. At the last controls (month 15), all the patients presented the nephrotic syndrome again. Conclusions: During its use, the tacrolimus was effective in patients with primary nephrotic syndrome and with
controlled dose, did not appeared side effects.