title: Long-term data on tacrolimus treatment in lupus nephritis.
abstract: OBJECTIVE
  Calcineurin inhibitors are effective immunosuppressants. They also reduce proteinuria in glomerular diseases but are potentially nephrotoxic. Short-term data suggest that tacrolimus (TAC) combined with corticosteroids is effective in LN, but long-term data are lacking. This study examined the long-term outcomes and tolerability of TAC for the treatment of LN.
  
  
  METHODS
  We retrospectively reviewed 29 LN patients who received TAC treatment for 46.9 months (s.d. 37.9).
  
  
  RESULTS
  In 17 patients with class III/IV or V LN and persistent proteinuria >2 g/day despite induction immunosuppression, response rates after 12 and 24 months of add-on TAC treatment were 66.7% and 80.0%, respectively. In 10 patients with nephrotic syndrome due to class V LN who were given prednisolone and TAC as initial treatment, the response rate was 60.0% and 90.0% after 12 and 24 months, respectively. TAC facilitated steroid minimization in two patients with lupus podocytopathy. As a group, proteinuria decreased from 3.6 g/day (s.d. 2.6) to 1.0 (s.d. 1.1) (P < 0.05). Four patients developed end-stage renal failure, with 3-, 5- and 8-year renal survival rates of 93%, 83% and 83%, respectively. In the remaining patients, serum creatinine and estimated GFR remained stable after 36 months. One patient with pre-existing chronic renal failure developed TAC nephrotoxicity. Four renal flares occurred, all associated with low TAC blood levels. Six patients (20.1%) had deterioration of hypertension and one patient (3.4%) had new-onset diabetes mellitus. Six patients (20.1%) had infections that required hospitalization. Two deaths occurred: one due to pneumonia and one to breast cancer.
  
  
  CONCLUSIONS
  The results suggest efficacy of TAC in LN, especially in reducing proteinuria, and its role as a long-term maintenance agent warrants further investigation.
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Maggie K M
authors.initials: MK
authors.lastname: Ma
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Maggie M Y
authors.initials: MM
authors.lastname: Mok
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Lorraine P Y
authors.initials: LP
authors.lastname: Kwan
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Gary C W
authors.initials: GC
authors.lastname: Chan
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China. dtmchan@hku.hk.
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D004341:Drug Evaluation / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D003404:Creatinine; D016559:Tacrolimus
keywords: long-term; lupus; nephritis; tacrolimus