title: Tacrolimus improves proteinuria remission in adults with cyclosporine A-resistant or -dependent minimal change disease.
abstract: OBJECTIVE
  Cyclosporin A (CsA) is considered as an effective treatment option for steroid-resistant or-dependent patients with adult-onset minimal change disease (MCD). However, CsA resistance or dependence is also observed in these patients. Tacrolimus (TAC) is a calcineurin inhibitor that is potent in cytokine suppression. The authors aim to evaluate the efficacy and safety of TAC therapy in CsA-resistant and-dependent adult-onset MCD patients.
  
  
  METHODS
  Patients with adult-onset MCD were enrolled in our department from 2008 to 2012. All patients were demonstrated to be resistant to or dependent on CsA therapy. Prednisone (0.5 mg/kg per day) combined with TAC (0.05-0.1 mg/kg per day) were prescribed to these patients for at least 6 months. The primary outcome was complete or partial remission of proteinuria. Secondary outcomes included time required for complete or partial remission, adverse events, number of relapses, and TAC dosages.
  
  
  RESULTS
  A total of 11 MCD patients were enrolled in this observational study. The numbers of patients who presented with resistance to or dependence on CsA were 7 and 4, respectively. The total remission rate was 90.9% (10/11) with the complete remission rate 72.7% (8/11). Most remission patients achieved remission during the first 2 months of TAC therapy. Patients who presented with dependence on CsA had achieved complete remission with TAC therapy, while outcomes for CsA-resistant patients were four complete remissions, two partial remissions and one resistance. The adverse events were observed in this study included infection, diarrhoea, and worsened hypertension. Five patients who had remission experienced relapse.
  
  
  CONCLUSIONS
  Tacrolimus improves proteinuria remission in adults with CsA-resistant or -dependent MCD.
authors.affiliation: Kidney Institute of PLA, Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Dechao
authors.initials: D
authors.lastname: Xu
authors.affiliation: Kidney Institute of PLA, Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Kidney Institute of PLA, Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Bian
authors.affiliation: Kidney Institute of PLA, Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
authors.affiliation: Kidney Institute of PLA, Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.|Department of Nephrology, Third affiliated Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chenggang
authors.initials: C
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications / Q000188:drug therapy*; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology; D012074:Remission Induction; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus
keywords: cyclosporine A; minimal change disease; nephrotic syndrome; proteinuria; tacrolimus