title: Evaluation of mycophenolate mofetil or tacrolimus in children with steroid sensitive but frequently relapsing or steroid-dependent nephrotic syndrome.
abstract: OBJECTIVE
  Approximately 30-40% of children with steroid sensitive nephrotic syndrome have frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS). Mycophenolate mofetil (MMF) and tacrolimus (TAC) are often alternative treatment choices for these patients.
  
  
  METHODS
  A single-center prospective study was conducted to compare the efficacy of MMF or TAC in reducing relapses and maintaining remission in children with FRNS or SDNS. Of the 72 recruited patients, either MMF (20∼30 mg/kg/d, n = 34) or TAC (0.05∼0.15 mg/kg/d, n = 38) was administered for 12 months.
  
  
  RESULTS
  The mean 6-month relapse rates decreased from 2.56 episodes before therapy to 0.76 episodes in the first 6 months after therapy (c(2) = 44.362, p < 0.001) and 0.67 in the next 6 months (c(2) = 37.817, p < 0.001) in the MMF group. In the TAC group, the mean 6-month relapse rates decreased from 2.39 episodes before therapy to 0.41 episodes in the first 6 months after therapy (c(2) = 62.242, p < 0.001) and 0.42 in next 6 months (c(2) = 67.482, p < 0.001). No significant difference in the relapse rate was found between the groups (before therapy, c(2) = 0.902, p = 0.637; first 6 months, c(2) = 5.358, p = 0.147; second 6 months, c(2) = 4.089, p = 0.252). And there was also no significant difference in cumulative sustained remission and the incidence of adverse events between two groups.
  
  
  CONCLUSIONS
  In combination with low-dose steroids, MMF or TAC presented similar efficacy in maintaining remission in children with FRNS/SDNS in the present study. Therapy with MMF or TAC is a promising strategy with a moderate risk of side effects in children who are steroid sensitive but have FRNS/SDNS.
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Junyi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Haidong
authors.initials: H
authors.lastname: Fu
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Huijun
authors.initials: H
authors.lastname: Shen
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Aimin
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shu
authors.affiliation: Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Lizhong
authors.initials: L
authors.lastname: Du
mesh_terms: D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002681:China; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: children; mycophenolate mofetil; primary nephrotic syndrome; tacrolimus