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See 1 citation in Nephrol Dial Transplant 2015:

Nephrol Dial Transplant. 2015 Mar;30(3):467-74. doi: 10.1093/ndt/gfu306. Epub 2014 Oct 1.

Predictors of response and relapse in patients with idiopathic membranous nephropathy treated with tacrolimus.

Author information

1
Hospital Universitario 12 de Octubre, Madrid, Spain.
2
Hospital Fundación Jiménez Díaz, Madrid, Spain.
3
Hospital Vall d'Hebron, Barcelona, Spain.
4
Hospital Universitario Reina Sofía, Córdoba, Spain.
5
Hospital Universitario Virgen de la Victoria, Málaga, Spain.
6
Hospital Universitario Regional de Málaga, Málaga, Spain.
7
Hospital Universitario Fundación Alcorcón, Madrid, Spain.
8
Hospital Universitario Gregorio Marañón, Madrid, Spain.
9
Hospital Universitario Central de Asturias, Oviedo, Spain.
10
Hospital Universitario Severo Ochoa, Leganés, Spain.
11
Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
12
Hospital General Universitario de Ciudad Real, Spain.
13
Hospital Universitario 12 de Octubre, Madrid, Spain Department of Medicine, Complutense University, Madrid, Spain.

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.

KEYWORDS:

membranous nephropathy; nephrotic syndrome; tacrolimus monotherapy

PMID:
25274748
DOI:
10.1093/ndt/gfu306
[Indexed for MEDLINE]

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