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Experience with tacrolimus in children with steroid-resistant nephrotic syndrome.

Butani L, Ramsamooj R - Pediatr. Nephrol. (2009)

Bottom Line: There was no significant association between tacrolimus exposure and biopsy changes, although the average trough level was higher in those children with worsening histological findings.In conclusion, tacrolimus may be a safe and effective alternative agent for inducing remission in children with SRNS.Serial renal biopsies are necessary to check for subclinical nephrotoxicity, especially in younger children and those with higher trough levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of California Davis Children's Hospital, 2516 Stockton Boulevard, Sacramento, CA 95817, USA. Lavjay.butani@ucdmc.ucdavis.edu

ABSTRACT
Children with steroid-resistant nephrotic syndrome (SRNS) are at risk of developing renal failure. We report here the results of a single-center retrospective observational study of the remission rate in pediatric patients with SNRS receiving tacrolimus. Serial renal biopsies from children on tacrolimus therapy were evaluated for tubulointerstitial fibrosis and transforming growth factor-beta immunostaining. Of the 16 children with SRNS, 15 went into complete remission after a median of 120 days of therapy. Nine children were able to stop steroids, while the others were on tapering doses. Forty-seven percent had relapses, most of which were steroid-responsive. Serial renal biopsies were obtained from seven children after a median treatment duration of 24 months; two of these children had increased tubulointerstitial fibrosis and four showed increased transforming growth factor-beta tissue staining. Children with worsening histological findings were younger. There was no significant association between tacrolimus exposure and biopsy changes, although the average trough level was higher in those children with worsening histological findings. In conclusion, tacrolimus may be a safe and effective alternative agent for inducing remission in children with SRNS. However, caution needs to be taken when prescribing this agent due to its narrow therapeutic index. Serial renal biopsies are necessary to check for subclinical nephrotoxicity, especially in younger children and those with higher trough levels.

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Related in: MedlinePlus

Biopsy with intense TGF-β staining (brown) in renal tubular nuclei
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Fig4: Biopsy with intense TGF-β staining (brown) in renal tubular nuclei

Mentions: Association between biopsy changes and demographic/Tac exposure variables


Experience with tacrolimus in children with steroid-resistant nephrotic syndrome.

Butani L, Ramsamooj R - Pediatr. Nephrol. (2009)

Biopsy with intense TGF-β staining (brown) in renal tubular nuclei
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697358&req=5

Fig4: Biopsy with intense TGF-β staining (brown) in renal tubular nuclei
Mentions: Association between biopsy changes and demographic/Tac exposure variables

Bottom Line: There was no significant association between tacrolimus exposure and biopsy changes, although the average trough level was higher in those children with worsening histological findings.In conclusion, tacrolimus may be a safe and effective alternative agent for inducing remission in children with SRNS.Serial renal biopsies are necessary to check for subclinical nephrotoxicity, especially in younger children and those with higher trough levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of California Davis Children's Hospital, 2516 Stockton Boulevard, Sacramento, CA 95817, USA. Lavjay.butani@ucdmc.ucdavis.edu

ABSTRACT
Children with steroid-resistant nephrotic syndrome (SRNS) are at risk of developing renal failure. We report here the results of a single-center retrospective observational study of the remission rate in pediatric patients with SNRS receiving tacrolimus. Serial renal biopsies from children on tacrolimus therapy were evaluated for tubulointerstitial fibrosis and transforming growth factor-beta immunostaining. Of the 16 children with SRNS, 15 went into complete remission after a median of 120 days of therapy. Nine children were able to stop steroids, while the others were on tapering doses. Forty-seven percent had relapses, most of which were steroid-responsive. Serial renal biopsies were obtained from seven children after a median treatment duration of 24 months; two of these children had increased tubulointerstitial fibrosis and four showed increased transforming growth factor-beta tissue staining. Children with worsening histological findings were younger. There was no significant association between tacrolimus exposure and biopsy changes, although the average trough level was higher in those children with worsening histological findings. In conclusion, tacrolimus may be a safe and effective alternative agent for inducing remission in children with SRNS. However, caution needs to be taken when prescribing this agent due to its narrow therapeutic index. Serial renal biopsies are necessary to check for subclinical nephrotoxicity, especially in younger children and those with higher trough levels.

Show MeSH
Related in: MedlinePlus