Tacrolimus therapy in pediatric patients with treatment-resistant nephrotic syndrome.

Abstract

This is a retrospective analysis of 16 children started on tacrolimus with various types of treatment-resistant nephrotic syndrome. There are 13 patients with focal glomerulosclerosis, 1 minimal change disease, and 2 IgA nephropathy with nephrosis. The mean age of the children was 11.4 years (range 3.5-18.1 years) with a mean age at diagnosis of 5.6 years (range 1.6-13.3 years). All patients initially received prednisone 2 mg/kg per day. Other therapies for 15 of 16 included cyclosporine (n=15), chlorambucil (n=5), mycophenolate mofetil (n=5), levamisole (n=3), i.v. methylprednisolone (n=3), and cyclophosphamide (n=2). The major indication for the initiation of tacrolimus included treatment resistance/dependence (n=15) and intolerable side effects from other therapies (n=1). The average time from the diagnosis to initiation of tacrolimus was 5.3 years (range 0.3-13.3 years, median 6 years). The initial dosage of tacrolimus utilized was 0.1 mg/kg per day divided into two doses. The mean follow-up period was 6.5 months (range 2.5-18 months). Thirteen patients (81%) went into a complete remission within an average of 2 months (range 0.5-5.5 months), with 3 patients relapsing while on treatment. Three patients did not respond. Of these, 2 had partial remissions (13%) and 1 failed to respond. Adverse events included anemia (n=1), seizure (n=1), worsening or new-onset hypertension (n=5), and sepsis (n=1). All patients remain on tacrolimus. Tacrolimus is an effective, well-tolerated medication for treatment-resistant forms of nephrotic syndrome in children, with a complete remission rate of 81% and a partial remission rate of 13% (totaling 94%).

• Authors: Kim Loeffler, Manjula Gowrishankar, Verna Yiu
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 19 Issue 3 Pg. 281-7 (Mar 2004) ISSN: 0931-041X [Print] Germany
• PMID: 14758528 (Publication Type: Journal Article)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antihypertensive Agents
• Glucocorticoids
• Immunosuppressive Agents
• Mycophenolic Acid
• Prednisone
• Tacrolimus

Topics

• Adolescent
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage)
• Antihypertensive Agents (administration & dosage)
• Child
• Child, Preschool
• Drug Resistance
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Hypertension, Renal (drug therapy)
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Male
• Mycophenolic Acid (administration & dosage, analogs & derivatives)
• Nephrotic Syndrome (drug therapy)
• Prednisone (administration & dosage)
• Retrospective Studies
• Tacrolimus (administration & dosage, adverse effects)
• Treatment Outcome