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Tacrolimus decreases proteinuria in patients with refractory IgA nephropathy.

Abstract In clinical practice, some IgA nephropathy (IgAN) patients show resistance to or are unable to achieve complete remission using steroids and/or immunosuppressants. The current study aimed to assess the efficacy and safety of tacrolimus in the treatment of cases of refractory IgAN.In this retrospective observational study, 34 primary IgAN patients with refractory proteinuria received tacrolimus for at least 12 months. Complete remission, partial remission, and other clinical data were measured at 1, 3, 6, and 12 months after the initiation of treatment.After 12 months, complete remission was achieved in 20 (58.8%) patients and partial remission in 5 (14.7%) patients, yielding a total response rate of 73.5%. The mean time for response to tacrolimus for those who achieved complete remission and partial remission was 7.0 ± 4.7 weeks. Serum creatinine (Scr), uric acid, estimated glomerular filtration rate, alanine aminotransferase, aspartate transaminase, white blood cell count, blood pressure, blood glucose, total cholesterol, and total triglyceride were stable over time. Three patients demonstrated a loss of eGFR >15 mL/min·1.73 m from baseline. Three cases of upper respiratory infection and 2 cases of urinary tract infection were observed during the study. Patients who achieved complete remission had better renal function and lower baseline proteinuria than partial remission and nonresponder patients. Crescent formation in biopsy specimens was seen more often in nonresponder patients.Tacrolimus was safe and effective at lowering proteinuria in refractory IgAN patients. Lower baseline proteinuria and better renal function were associated with a higher probability of complete remission, while crescent formation was associated with a worse prognosis.
PMID
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Tacrolimus improves the proteinuria remission in patients with refractory IgA nephropathy.

Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29718866
OWN - NLM
STAT- MEDLINE
DCOM- 20180508
LR  - 20180508
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 18
DP  - 2018 May
TI  - Tacrolimus decreases proteinuria in patients with refractory IgA nephropathy.
PG  - e0610
LID - 10.1097/MD.0000000000010610 [doi]
AB  - In clinical practice, some IgA nephropathy (IgAN) patients show resistance to or 
      are unable to achieve complete remission using steroids and/or
      immunosuppressants. The current study aimed to assess the efficacy and safety of 
      tacrolimus in the treatment of cases of refractory IgAN.In this retrospective
      observational study, 34 primary IgAN patients with refractory proteinuria
      received tacrolimus for at least 12 months. Complete remission, partial
      remission, and other clinical data were measured at 1, 3, 6, and 12 months after 
      the initiation of treatment.After 12 months, complete remission was achieved in
      20 (58.8%) patients and partial remission in 5 (14.7%) patients, yielding a total
      response rate of 73.5%. The mean time for response to tacrolimus for those who
      achieved complete remission and partial remission was 7.0 +/- 4.7 weeks. Serum
      creatinine (Scr), uric acid, estimated glomerular filtration rate, alanine
      aminotransferase, aspartate transaminase, white blood cell count, blood pressure,
      blood glucose, total cholesterol, and total triglyceride were stable over time.
      Three patients demonstrated a loss of eGFR >15 mL/min.1.73 m from baseline. Three
      cases of upper respiratory infection and 2 cases of urinary tract infection were 
      observed during the study. Patients who achieved complete remission had better
      renal function and lower baseline proteinuria than partial remission and
      nonresponder patients. Crescent formation in biopsy specimens was seen more often
      in nonresponder patients.Tacrolimus was safe and effective at lowering
      proteinuria in refractory IgAN patients. Lower baseline proteinuria and better
      renal function were associated with a higher probability of complete remission,
      while crescent formation was associated with a worse prognosis.
FAU - Hu, Tingyang
AU  - Hu T
AD  - Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong
      University of Science and Technology, Wuhan, Hubei, People's Republic of China.
FAU - Liu, Qingquan
AU  - Liu Q
FAU - Xu, Qing
AU  - Xu Q
FAU - Liu, Hui
AU  - Liu H
FAU - Qiu, Wenhui
AU  - Qiu W
FAU - Huang, Fei
AU  - Huang F
FAU - Zhang, Shijie
AU  - Zhang S
FAU - Lv, Yongman
AU  - Lv Y
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Immunosuppressive Agents)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Female
MH  - Glomerulonephritis, IGA/*drug therapy/*urine
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Proteinuria/*drug therapy
MH  - Remission Induction
MH  - Respiratory Tract Infections/chemically induced
MH  - Retrospective Studies
MH  - Tacrolimus/adverse effects/*therapeutic use
MH  - Urinary Tract Infections/chemically induced
MH  - Young Adult
EDAT- 2018/05/03 06:00
MHDA- 2018/05/09 06:00
CRDT- 2018/05/03 06:00
PHST- 2018/05/03 06:00 [entrez]
PHST- 2018/05/03 06:00 [pubmed]
PHST- 2018/05/09 06:00 [medline]
AID - 10.1097/MD.0000000000010610 [doi]
AID - 00005792-201805040-00034 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(18):e0610. doi: 10.1097/MD.0000000000010610.