title: Predictors of response and relapse in patients with idiopathic membranous nephropathy treated with tacrolimus.
abstract: BACKGROUND
  Although tacrolimus is recommended by KDIGO Clinical Practice Guideline for Glomerulonephritis for the treatment of idiopathic membranous nephropathy (MN), little is known about factors that influence response and relapse of the disease after tacrolimus therapy.
  
  
  METHODS
  Multicentre study that collected 122 MN patients with nephrotic syndrome and stable renal function treated with tacrolimus. Duration of treatment was 17.6 ± 7.2 months, including a full-dose and a tapering period.
  
  
  RESULTS
  The percentage of remission was 60, 78 and 84% after 6, 12 and 18 months of treatment, respectively. The amount of proteinuria at baseline significantly predicted remission, the lower the baseline proteinuria the higher the probability of remission. Only 10 patients (8%) received concomitantly corticosteroids, and their rate of remission was similar (80% at 18 months). Among responders, 42% achieved complete remission (CR) and 58% partial remission (PR). Almost half (44%) of the responder patients relapsed. The amount of proteinuria at the onset of tacrolimus tapering was significantly higher in relapsing patients. By multivariable analysis, the presence of a PR versus CR at the onset of tacrolimus tapering and a shorter duration of the tapering period significantly predicted relapses. Tolerance was good and the number of adverse events low.
  
  
  CONCLUSIONS
  Tacrolimus monotherapy is an effective and safe option for the treatment of MN with stable renal function. Relapses are frequent in patients with PR and can be partially prevented by a longer tapering period.
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Jara
authors.initials: J
authors.lastname: Caro
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gutiérrez-Solís
authors.affiliation: Hospital Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rojas-Rivera
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Agraz
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Ramos
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Rabasco
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Espinosa
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Valera
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Martín
authors.affiliation: Hospital Universitario Regional de Málaga, Málaga, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Frutos
authors.affiliation: Hospital Universitario Regional de Málaga, Málaga, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Perea
authors.affiliation: Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Gema Fernández
authors.initials: GF
authors.lastname: Juárez
authors.affiliation: Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ocaña
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Arroyo
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Marian
authors.initials: M
authors.lastname: Goicoechea
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Fernández
authors.affiliation: Hospital Universitario Severo Ochoa, Leganés, Spain.
authors.forename: Aniana
authors.initials: A
authors.lastname: Oliet
authors.affiliation: Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Hernández
authors.affiliation: Hospital General Universitario de Ciudad Real, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Romera
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Alfons
authors.initials: A
authors.lastname: Segarra
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain Department of Medicine, Complutense University, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
mesh_terms: D016022:Case-Control Studies; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000175:diagnosis* / Q000453:epidemiology*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: membranous nephropathy; nephrotic syndrome; tacrolimus monotherapy