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Treatment of tacrolimus or cyclosporine A in children with idiopathic nephrotic syndrome

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Abstract

Background

Cyclosporine A (CsA) and tacrolimus (TAC) are often alternative treatment choices for patients with nephrotic syndrome.

Methods

In this prospective study, the efficacy and safety of CsA and TAC in inducing and maintaining remission in 74 children with idiopathic nephrotic syndrome (INS) were evaluated.

Results

In terms of short-term efficacy, TAC was more effective than CsA in children with steroid-resistant nephrotic syndrome (χ2 = 13.75, P = 0.001), although no significant difference in number of episodes of relapse were found in patients with complete remission between the two treatment groups (first year: χ2 = 0.261, P = 0.88; second year: χ2 = 2.685, P = 0.26). In patients with frequently relapsing or steroid-dependent nephrotic syndrome, no significant difference in short-term remission (χ2 = 1.908, P = 0.39) or in relapse frequency during follow-up (within first year: χ2 = 1.046, P = 0.59; within second year: χ2 = 0.587, P = 0.75) were found between the two groups. There was a difference in the rate of adverse effects between the two treatment groups [nephrotoxicity: 4/24 (CsA) vs .0/50 (TAC), P = 0.002; hirsutism: 8/24 (CsA) vs. 0/50 (TAC), P < 0.001].

Conclusions

In our pediatric patient cohort, the treatment of steroid-resistant nephrotic syndrome with tacrolimus was associated with higher efficacy and lower renal toxicity in comparison to CsA, although no favorable outcome in relapse rate during long-term follow-up was seen. On the other hand, tacrolimus was not always the better choice to replace CsA in the treatment of severe frequently relapsing or steroid-dependent nephrotic syndrome.

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Acknowledgments

The project was supported by the National Natural Science Foundation of China (Grant No. 30971365, 81070561, and 81170664), Zhejiang Provincial Healthy Science Foundation of China (WKJ2010-2-014, 2012KYA119), Zhejiang Provincial Program for the Cultivation of High-level Innovative Health Talents and Zhejiang Provincial Natural Science Foundation of China (Y12H050037). We thank all patients for participating in the study.

Conflict of interest statement

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Authors and Affiliations

  1. Department of Nephrology, The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China

    Wenjing Wang, Yonghui Xia, Jianhua Mao, Yifang Chen, Dayan Wang, Huijun Shen, Haidong Fu, Lizhong Du & Ai’min Liu

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  1. Wenjing Wang
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  2. Yonghui Xia
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Correspondence to Jianhua Mao.

Additional information

Wenjing Wang and Yonghui Xia contributed equally to this work.

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Wang, W., Xia, Y., Mao, J. et al. Treatment of tacrolimus or cyclosporine A in children with idiopathic nephrotic syndrome. Pediatr Nephrol 27, 2073–2079 (2012). https://doi.org/10.1007/s00467-012-2228-3

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  • DOI: https://doi.org/10.1007/s00467-012-2228-3

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