Complete remissioninducedbytacrolimusandlow-doseprednisolonein adult minimalchangenephroticsyndrome:Apilotstudy

Background: Few clinicaltrialshaveexaminedthereplacementofsteroidswith other immunosuppressivedrugsasaprimarytreatmentmodalityforminimal change disease(MCD)inadults.Westudiedtheefficacyoftacrolimustoinduce complete remission(CR)inadultswithMCD. Methods: We enrolled14adultswithMCDandnephrotic-rangeproteinuria.All patients weretreatedwithoraltacrolimus0.05mg/kgtwicedailyandpredniso-lone 0.5mg/kg/day.CRwasdefinedasaurineproteintocreatinineratioofo0.2 g protein/g creatinine(g/gcr).Theprimaryoutcomewascumulativepercentageof CR during16weeks. Results: The meanurineproteintocreatinineratioatenrollmentwas10.9g/gcr (range: 4.2–18.1g/gcr).Thetroughtacrolimuslevelwasmaintainedat5.9972.63 ng/mL.CRwasachievedby13/14(92.8%)patientswithin8weeks.The cumulative CRratewas7.7%(1/14),64.2%(9/14),71.3%(10/14),and92.9%(13/14)at 1week,2weeks,4weeks,and8weeks,respectively.Theoneremainingpatient achieved CRat20weeksaftertreatment,whowasfollowedupforafurther 4 weeks.ThemeantimetoachieveCRinthe14patientswas4.6475.11 (1–20)weeks. Threecasessufferedadverseeventsofabdominalpain,diarrhea,ornew-onset diabetesmellitus. Conclusion: Tacrolimusandlow-doseprednisolonetherapyinducedCRrapidly (71.3% by4weeksand100%by20weeks)andeffectivelyinadultpatientswithMCD. KCI Citation Count: 1