Pediatric Nephrology

, Volume 21, Issue 12, pp 1913–1914 | Cite as

Tacrolimus for the treatment of focal segmental glomerulosclerosis resistant to cyclosporine A

  • Koichi SuzukiEmail author
  • Koji Tsugawa
  • Hiroshi Tanaka
Letter to the Editors


We read with great interest the article by Loeffler et al. [1] referring to the efficacy of tacrolimus (TL) in children with refractory nephrotic syndrome (NS). However, there is little published information on TL treatment of childhood focal segmental glomerulosclerosis (FSGS) [1, 2]. In this letter, we report on two pediatric patients with cyclosporine A (CsA)-resistant FSGS in whom successful and rapid clinical remission and reduction in the dose of prednisolone (PSL) were achieved following TL treatment.

Case 1

A 9-year-old Japanese boy was referred to our hospital with a 2-month history of unremitting steroid-resistant proteinuria. A percutaneous renal biopsy revealed lesions characteristic of FSGS. Despite aggressive immunosuppressive therapy, such as methylprednisolone pulse therapy (MPT), and therapy with cyclophosphamide (CPM), mizoribine (MZR) and CsA at the dose of 5.0 mg/kg daily [3], the heavy proteinuria persisted for the next 6 months. The trough blood level of CsA...


Cyclosporine Tacrolimus Nephrotic Syndrome Clinical Remission Severe Adverse Effect 
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  1. 1.
    Loeffler K, Gowrishankar M, Yiu V (2004) Tacrolimus therapy in pediatric patients with treatment-resistant nephrotic syndrome. Pediatr Nephrol 19:281–287CrossRefGoogle Scholar
  2. 2.
    McCauley J, Shapiro R, Ellis D, Igdal H, Tzakis A, Starzl TE (1993) Pilot trial of FK 506 in the management of steroid-resistant nephrotic syndrome. Nephrol Dial Transplant 8:1286–1290PubMedPubMedCentralGoogle Scholar
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    Tsugawa K, Tanaka H, Nakahata T, Ito E (2004) Effective therapy of a child case of refractory nephrotic syndrome with tacrolimus. Tohoku J Exp Med 204:237–241CrossRefGoogle Scholar
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    Tanaka H, Tsugawa K, Nakahata T, Kudo M, Onuma S, Kimura S, Ito E (2005) Mizoribine pulse therapy for a pediatric patient with steroid-resistant nephrotic syndrome. Tohoku J Exp Med 205:87–91CrossRefGoogle Scholar
  5. 5.
    Segarra A, Vila J, Pou L, Majo J, Arbos A, Quiles T, Piera L (2002) Combined therapy of tacrolimus and corticosteroids in cyclosporine-resistant or -dependent idiopathic focal glomerulosclerosis: a preliminary uncontrolled study with prospective follow-up. Nephrol Dial Transplant 17:655–662CrossRefGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  1. 1.Department of PediatricsHirosaki University School of MedicineHirosakiJapan

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