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Effect of tacrolimus plus mycophenolate mofetil in the therapy of children with steroid-resistant nephrotic syndrome

Lili Zhao(1), Jia Hao(2), Lei Zhang(3),


(1) Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
(2) Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
(3) Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
Corresponding Author

Abstract


This study mainly explored the influence of tacrolimus in association with mycophenolate mofetil (MMF, CellCept) in treating steroid-resistant nephrotic syndrome (SRNS) children. A total of 124 SRNS children were chosen and separated into observation group and control group. The control group received basic treatment and tacrolimus treatment. In contrast, the observation group received MMF in addition to basic and tacrolimus treatments. The results showed that the observation group presented higher total effective rate, better improvements of 24 h urinary protein quantification, than the control group. Albumin and cholesterol levels, lower fibrinogen level, lower blood urea nitrogen, serum creatinine, along with cystatin C levels, better improvements of interferon γ, interleukin-2 and interleukin -13 levels, and lower total occurrence of adverse reactions. We conclude that Tacrolimus combined with MMF can effectively reduce inflammation along with improve the renal function of SRNS children.

References


Wang CS and Greenbaum LA. Nephrotic Syndrome. Pediatr

Clin North Am. 2019; 66(1): 73-85.

Rodriguez-Ballestas E and Reid-Adam J. Nephrotic

Syndrome. Pediatr Rev. 2022; 43(2): 87-99.

Trautmann A, Schnaidt S, Lipska-Ziętkiewicz BS, Bodria M,

Ozaltin F, Emma F, Anarat A, Melk A, Azocar M, Oh

J, Saeed B, Gheisari A, Caliskan S, Gellermann J,

Higuita LMS, Jankauskiene A, Drozdz D, Mir S, Balat

A, Szczepanska M, Paripovic D, Zurowska A,

Bogdanovic R, Yilmaz A, Ranchin B, Baskin E,

Erdogan O, Remuzzi G, Firszt-Adamczyk A, Kuzma

Mroczkowska E, Litwin M, Murer L, Tkaczyk M,

Jardim H, Wasilewska A, Printza N, Fidan K,

Simkova E, Borzecka H, Staude H, Hees K and

Schaefer F. Long-Term Outcome of Steroid-Resistant

Nephrotic Syndrome in Children. J Am Soc Nephrol.

; 28(10): 3055-3065.

Warejko JK, Tan W, Daga A, Schapiro D, Lawson JA, Shril

S, Lovric S, Ashraf S, Rao J, Hermle T, Jobst-Schwan

T, Widmeier E, Majmundar AJ, Schneider R, Gee HY,

Schmidt JM, Vivante A, van der Ven AT, Ityel H,

Chen J, Sadowski CE, Kohl S, Pabst WL, Nakayama

M, Somers MJG, Rodig NM, Daouk G, Baum M,

Stein DR, Ferguson MA, Traum AZ, Soliman NA,

Kari JA, El Desoky S, Fathy H, Zenker M, Bakkaloglu

SA, Müller D, Noyan A, Ozaltin F, Cadnapaphornchai

MA, Hashmi S, Hopcian J, Kopp JB, Benador N,

Bockenhauer D, Bogdanovic R, Stajić N, Chernin G,

Ettenger R, Fehrenbach H, Kemper M, Munarriz RL,

Podracka L, Büscher R, Serdaroglu E, Tasic V, Mane

S, Lifton RP, Braun DA and Hildebrandt F. Whole

Exome Sequencing of Patients with Steroid-Resistant

Nephrotic Syndrome. Clin J Am Soc Nephrol. 2018;

(1): 53-62.

Shin JI, Kronbichler A, Oh J and Meijers B. Nephrotic

Syndrome: Genetics, Mechanism, and Therapies.

Biomed Res Int. 2018; 20186215946.

Campbell RE and Thurman JM. The Immune System and

Idiopathic Nephrotic Syndrome. Clin J Am Soc

Nephrol. 2022; 17(12): 1823-1834.

Schutte-Nutgen K, Tholking G, Suwelack B and Reuter S.

Tacrolimus - Pharmacokinetic Considerations for

Clinicians. Curr Drug Metab. 2018; 19(4): 342-350.

Chakrabarti K, Frame D, Al Abbas M and McCune WJ. The

use of mycophenolate mofetil area under the curve.

Curr Opin Rheumatol. 2021; 33(3): 221-232.

Iijima K, Sako M, Oba M, Tanaka S, Hamada R, Sakai T,

Ohwada Y, Ninchoji T, Yamamura T, Machida H,

Shima Y, Tanaka R, Kaito H, Araki Y, Morohashi T,

Kumagai N, Gotoh Y, Ikezumi Y, Kubota T, Kamei

K, Fujita N, Ohtsuka Y, Okamoto T, Yamada T,

Tanaka E, Shimizu M, Horinouchi T, Konishi A,

Omori T, Nakanishi K, Ishikura K, Ito S, Nakamura H

and Nozu K. Mycophenolate Mofetil after Rituximab

for

Childhood-Onset Complicated Frequently

Relapsing or Steroid-Dependent Nephrotic Syndrome.

J Am Soc Nephrol. 2022; 33(2): 401-419.

Tullus K, Webb H and Bagga A. Management of steroid

resistant nephrotic syndrome in children and

adolescents. Lancet Child Adolesc Health. 2018;

(12): 880-890.

Lee JM, Kronbichler A, Shin JI and Oh J. Current

understandings in treating children with steroid

resistant nephrotic syndrome. Pediatr Nephrol. 2021;

(4): 747-761.

Noone DG, Iijima K and Parekh R. Idiopathic nephrotic

syndrome in children. Lancet. 2018; 392(10141): 61

Hejazian SM, Zununi Vahed S, Moghaddas Sani H,

Nariman-Saleh-Fam Z, Bastami M, Hosseiniyan

Khatibi SM, Ardalan M and Samadi N. Steroid

resistant nephrotic syndrome: pharmacogenetics and

epigenetic points and views. Expert Rev Clin

Pharmacol. 2020; 13(2): 147-156.

Kamei K, Ishikura K, Sako M, Ito S, Nozu K and Iijima K.

Rituximab therapy for refractory steroid-resistant

nephrotic syndrome in children. Pediatr Nephrol.

; 35(1): 17-24.

Zhao QC, Li WN, Li ZJ, Li Y and Sun DH. Effect of

voriconazole combined with glucocorticoid on

nephrotic syndrome in children. Eur Rev Med

Pharmacol Sci. 2021; 25(15): 5018-5025.

Basu B, Sander A, Roy B, Preussler S, Barua S, Mahapatra

TKS and Schaefer F. Efficacy of Rituximab vs

Tacrolimus in Pediatric Corticosteroid-Dependent

Nephrotic Syndrome: A Randomized Clinical Trial.

JAMA Pediatr. 2018; 172(8): 757-764.

Shumei Y, Yi L, Huanyu M, Zhibin L, Wanlin J, Liqun X

and Huan Y. IL-2 gene polymorphisms affect

tacrolimus response in myasthenia gravis. Eur J Clin

Pharmacol. 2019; 75(6): 795-800.

Chen HX, Cheng Q, Li F, He QN, Cao Y, Yi ZW and Wu

XC. Efficacy and safety of tacrolimus and low-dose

prednisone in Chinese children with steroid-resistant

nephrotic syndrome. World J Pediatr. 2020; 16(2):

-167.

Maripuri S and Kasiske BL. The role of mycophenolate

mofetil in kidney transplantation revisited. Transplant

Rev (Orlando). 2014; 28(1): 26-31.

Moreno-Arquieta IA, Cardenas-de la Garza JA, Esquivel

Valerio JA, Riega-Torres J, Cuellar-Barboza A, Herz

Ruelas ME, Ocampo-Candiani J and Galarza-Delgado

DA. Mycophenolate mofetil and mycophenolic acid

for the treatment of eosinophilic fasciitis: report of two

cases and literature review. J Dermatolog Treat. 2022;

(3): 1765-1768.

Roberti I and Vyas S. Long-term outcome of children with

steroid-resistant nephrotic syndrome treated with

tacrolimus. Pediatr Nephrol. 2010; 25(6): 1117-1124.


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