Management of steroid-resistant focal segmental glomerulosclerosis in children using tacrolimus.

Abstract

BACKGROUND:

The use of tacrolimus in steroid-resistant (SR) focal segmental glomerulosclerosis (FSGS) has been reported in single and small series case reports.

AIM:

To determine the efficacy of tacrolimus in the management of SR FSGS in children.

STUDY DESIGN:

This was a prospective study of 20 children with SR FSGS treated with tacrolimus (0.2-0.4 mg/kg/day in two divided doses over 12 h adjusted to a trough level between 7 and 15 ng/ml) for 12 months in combination with low-dose steroids. Other therapies included angiotensin-converting enzyme inhibitors, folic acid, multivitamins and lipid-lowering agents.

RESULTS:

The mean age at study entry was 11.1 years (range 5.6-16.8). The mean duration of nephrotic syndrome before initiation of tacrolimus therapy was 4.7 years (range 2.1-7.6). At the end of the treatment period, 8 (40%) children were in complete remission, 9 (45%) were in partial remission, and 3 (15%) failed to respond. The average follow-up period following cessation of tacrolimus treatment was 27.5 months (range 13.7-43.7). At last hospital follow-up, 5 (25%) children were in complete remission, 10 (50%) in partial remission, and 2 (10%) in relapse. Three children died from dialysis-related complications following cessation of tacrolimus treatment. Adverse events included sepsis (2), nausea (2), diarrhea (2), anemia (4) and worsening of hypertension (4).

CONCLUSION:

Tacrolimus is a safe and effective treatment for SR FSGS. However, like cyclosporine, some children tend to relapse following cessation of treatment.

• Authors: Rajendra Bhimma, Miriam Adhikari, Kareshma Asharam, Catherine Connolly
• Journal: American journal of nephrology (Am J Nephrol) Vol. 26 Issue 6 Pg. 544-51 ( 2006) ISSN: 1421-9670 [Electronic] Switzerland
• PMID: 17159342 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2006 S. Karger AG, Basel.

Chemical References

• Immunosuppressive Agents
• Steroids
• Tacrolimus

Topics

• Adolescent
• Child
• Female
• Glomerulosclerosis, Focal Segmental (drug therapy)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Male
• Steroids (therapeutic use)
• Tacrolimus (adverse effects, therapeutic use)
• Treatment Outcome