Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome

Li, Xiayu; Li, Heng; Chen, Jianghua; He, Qing; Lü, Rong; Lin, Weihong; Li, Qun; He, Xiaofeng; Qu, Lihui; Wang, Suya

doi:10.1093/ndt/gfm637

Cited by 51 publications

(63 citation statements)

References 21 publications

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“…The cumulative rate of remission peaked at 6 months. 54,56 Tacrolimus achieved 6-month and 2-year remission rates of 79%-91% and 50%-62% in SD/SR MCD patients as noted above, 46,47 and it may allow for the discontinuation of steroids. Tacrolimus has also shown efficacy in case reports 57 and case series, 18,58,59 with remission rates of 64%-100% in this limited experience.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 79%

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The Treatment of Minimal Change Disease in Adults

Hogan

Radhakrishnan

2013

Journal of the American Society of Nephrology

128

123

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Minimal change disease (MCD) is the etiology of 10%-25% of cases of nephrotic syndrome in adults. The mainstay of treatment for adult MCD, oral gucocorticoids, is based on two randomized controlled trials and extensive observational data in adults, and this treatment leads to remission in over 80% of cases. Relapses are common, and some patients become steroid-resistant (SR), steroid-dependent (SD), or frequently relapsing (FR). The data guiding the treatment of these patients are limited. Here, we review MCD in adults with particular focus on the evidence for immunosuppressive therapy in these patients.

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Section: Calcineurin Inhibitorsmentioning

confidence: 79%

“…46,47 Intravenous CYC was chosen because of the higher rates of remission, lower incidence of adverse events, and lower cumulative medication dose of intravenous CYC compared with oral CYC in children with SR-MCD. 48,49 The first study randomized 26 adults with SD MCD to receive tacrolimus (n=12; dosed Table 2.…”

Section: Alkylating Agentsmentioning

confidence: 99%

The Treatment of Minimal Change Disease in Adults

Hogan

Radhakrishnan

2013

Journal of the American Society of Nephrology

128

123

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“…Some patients may relapse once CsA is discontinued. Only one study has been conducted in frequently relapsing NS or steroiddependent NS, showing that TAC was equally effective to intravenous cyclophosphamide in inducing and maintaining remission at 2 years in 26 adults who had been previously treated with prednisone at onset (70). MMF use has been reported only in small patient cohorts, showing efficacy in about 60%-70% of patients (71,72).…”

Section: Adultsmentioning

confidence: 99%

Minimal Change Disease

Vivarelli

Massella

Ruggiero

et al. 2016

CJASN

395

383

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Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS), characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it accounts for approximately 15% of patients with idiopathic NS, reaching a much higher percentage at younger ages, up to 70%-90% in children >1 year of age. In the pediatric setting, a renal biopsy is usually not performed if presentation is typical and the patient responds to therapy with oral prednisone at conventional doses. Therefore, in this setting steroid-sensitive NS can be considered synonymous with MCD. The pathologic hallmark of disease is absence of visible alterations by light microscopy and effacement of foot processes by electron microscopy. Although the cause is unknown and it is likely that different subgroups of disease recognize a different pathogenesis, immunologic dysregulation and modifications of the podocyte are thought to synergize in altering the integrity of the glomerular basement membrane and therefore determining proteinuria. The mainstay of therapy is prednisone, but steroid-sensitive forms frequently relapse and this leads to a percentage of patients requiring second-line steroid-sparing immunosuppression. The outcome is variable, but forms of MCD that respond to steroids usually do not lead to chronic renal damage, whereas forms that are unresponsive to steroids may subsequently reveal themselves as FSGS. However, in a substantial number of patients the disease is recurrent and requires long-term immunosuppression, with significant morbidity because of side effects. Recent therapeutic advances, such as the use of anti-CD20 antibodies, have provided long-term remission off-therapy and suggest new hypotheses for disease pathogenesis.

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“…The calcineurin inhibitors cyclosporine or tacrolimus are alternatives for patients who are steroid dependent, relapse after cyclophosphamide, or have contraindications for cyclophosphamide (39,(47)(48)(49)(50)(51)(52). Approximately 70%-90% of patients with MCD who are frequent relapsers or are steroid dependent can be maintained in partial or complete remission with calcineurin inhibitors (53).…”

Section: Discussion Of Casementioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2013

Fervenza

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

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The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories, along with single best answer questions, were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the NQ&Q was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responses and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for CJASN readers. Enjoy the clinical cases and expert discussions.

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Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome

Abstract: A 24-week course of TAC is a favorable steroid-sparing agent for treatment of Chinese adults with SD-MCNS. Therapy with TAC accompanied by a tapering dose of prednisolone appears to yield quicker remission than treatment with CYC together with prednisone.

Cited by 51 publications

References 21 publications

The Treatment of Minimal Change Disease in Adults

The Treatment of Minimal Change Disease in Adults

Minimal Change Disease

American Society of Nephrology Quiz and Questionnaire 2013

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