Combined therapy of tacrolimus and corticosteroids in cyclosporin‐resistant or ‐dependent idiopathic focal glomerulosclerosis: a preliminary uncontrolled study with prospective follow‐up†
| العنوان: | Combined therapy of tacrolimus and corticosteroids in cyclosporin‐resistant or ‐dependent idiopathic focal glomerulosclerosis: a preliminary uncontrolled study with prospective follow‐up† |
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| المؤلفون: | Leonor Pou, Antonia Arbós, Teresa Quiles, Josefa Vila, Luis Piera, Joaquim Majo, Alfons Segarra |
| المصدر: | Nephrology Dialysis Transplantation. 17:655-662 |
| بيانات النشر: | Oxford University Press (OUP), 2002. |
| سنة النشر: | 2002 |
| مصطلحات موضوعية: | Adult, medicine.medical_specialty, Drug Resistance, Kidney, Gastroenterology, Tacrolimus, Adrenal Cortex Hormones, Prednisone, Internal medicine, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Transplantation, Proteinuria, Glomerulosclerosis, Focal Segmental, business.industry, Glomerulosclerosis, Middle Aged, medicine.disease, Surgery, Nephrology, Cyclosporine, Trough level, Drug Therapy, Combination, medicine.symptom, business, Nephrotic syndrome, Immunosuppressive Agents, Follow-Up Studies, medicine.drug, Kidney disease |
| الوصف: | Background. Cyclosporin has improved the outcome for steroid-resistant patients with focal glomerulosclerosis, but there is a proportion of patients that are either cyclosporin-resistant or suffer relapses, needing long-term therapy to sustain the remission. In these cases, preliminary reports suggest that tacrolimus could be an alternative therapy, but to date the evidence is limited to small series of patients with no long-term follow-up. Methods. In this study we analysed the efficacy and safety of a combined therapy of tacrolimus and steroids in 25 patients (mean serum creatinines 1.24"0.49 mgudl; mean proteinurias 10.2"9.5 guday; mean serum albumins2.4"0.58 gudl) with idiopathic primary focal glomerulosclerosis and proven resistance to or dependence on cyclosporin A. Results. After a 6 months trial of tacrolimus and steroids, proteinuria decreased in 17 patients (68%) (complete remission in 10 patients (40%), partial remission in two patients (8%) and a moderate reduction in proteinuria to levels - 3g uday was seen in five additional patients (20%)). The only predictor of response to tacrolimus was a previous response to cyclosporin and prednisone, either as a complete or partial remission (remission rate 75% vs 15.3; Ps0.036). Mean time to remission was 112"24 days. After tacrolimus discontinuation, 13u17 patients (76%) relapsed and were treated with a second trial of tacrolimus for 1 year, achieving complete remission in five patients (38.4%), partial remission in four patients (30.7%) and reduction of proteinuria - 3g uday in four patients (30.7%). After 2 years of follow-up, 12 patients (48%) were on sustained remission. The main side effect was acute reversible nephrotoxicity (40%). Predictors of renal toxicity were age (Ps 0.037), baseline creatinine (Ps 0.046) and tacrolimus trough level (Ps0.001). Conclusions. We conclude that combined therapy of tacrolimus and steroids induce sustained remission of proteinuria in a significant number of patients with idiopathic focal glomerulosclerosis whose disease was not controlled by the standard therapy of steroids and cyclosporin A. |
| تدمد: | 1460-2385 0931-0509 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::539f4b4982a86bc82b6ac033ae567afd https://doi.org/10.1093/ndt/17.4.655 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....539f4b4982a86bc82b6ac033ae567afd |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14602385 09310509 |
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