Diltiazem used as a tacrolimus-sparing agent for treatment of pediatric patients with refractory nephrotic syndrome: a case report and retrospective analysis

  • Jie-Yu Sun
  • Ya-Hui Hu
  • Hong-Li Guo
  • Xia Jing
  • Ze-Jun Xu
  • Fang Sun
  • Hui-Lei Guo
  • Xuan-Sheng Ding
  • Feng ChenEmail author
  • Jing XuEmail author
Letter to the Editor

Case report

Tacrolimus is used to treat nephrotic syndrome with close monitoring of its blood level due to its narrow therapeutic window and chronic nephrotoxicity [1, 2].

A 5-year-old boy was referred to our hospital in March 2017 (day 0) because he had continued to suffer from vomiting, abdominal pain, and systemic edema since a month ago. The laboratory results exhibited a large number of urinary proteins (24-h urine protein, 4.51 g/L), hypoalbuminemia (albumin, 14.6 g/L), hypercholesterolemia (total cholesterol, 8.06 mmol/L), and systemic edema. This patient had no food or drug allergic history. He was initially diagnosed with nephrotic syndrome and received a standard amount of oral corticosteroids (prednisone 40 mg qd) for 4-week period therapy. After 18-day medication (day 18), however, there was still a large amount of protein in his urine. He was hospitalized. On April 5 (day 28), renal biopsy results indicated this boy was with IgM nephropathy. Other relevant laboratory tests...


Authors’ contributions

J.Y. Sun, Y.H. Hu, and H.L. Guo measured blood tacrolimus concentrations and detected the CYP3A5 genotype. Z.J. Xu, X. Jing, F. Sun, and X.S. Ding involved in counseling on drug therapy. H.L. Guo was responsible for the patients. J.Y. Sun, H.L. Guo, and F. Chen analyzed the data and wrote the manuscript. J. Xu critically revised the manuscript.

Funding information

This work was supported by the Hospital Pharmacy Foundation of Jiangsu Pharmaceutical Association (A201606 and 2016YX011).

Compliance with ethical standards

The ethical approval was provided by the IEC of Children’s Hospital Affiliated to Nanjing Medical University. The informed consent was obtained from the children’s parents.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

228_2018_2604_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PharmacyChildren’s Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.School of Basic Medicine and Clinical PharmacyChina Pharmaceutical UniversityNanjingChina

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