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中华肾病研究电子杂志 ›› 2014, Vol. 03 ›› Issue (04) : 200 -203. doi: 10.3877/cma.j.issn.2095-3216.2014.04.006

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他克莫司在肾脏病中的合理应用
汪年松1,(), 桂定坤1, 李军辉1   
  1. 1.200233 上海交通大学附属第六人民医院肾内科
  • 出版日期:2014-08-15
  • 通信作者: 汪年松

Reasonable application of tacrolimus in renal diseases

Niansong Wang1,(), Dingkun Gui1, Junhui Li1   

  1. 1.Department of Nephrology, Sixth People's Hospital Affiliated to Shanghai Jiaotong University. Shanghai 200233, China
  • Published:2014-08-15
  • Corresponding author: Niansong Wang
引用本文:

汪年松, 桂定坤, 李军辉. 他克莫司在肾脏病中的合理应用[J/OL]. 中华肾病研究电子杂志, 2014, 03(04): 200-203.

Niansong Wang, Dingkun Gui, Junhui Li. Reasonable application of tacrolimus in renal diseases[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2014, 03(04): 200-203.

他克莫司是一种新型免疫抑制剂,可保护足细胞,降低尿蛋白。 近年来研究表明他克莫司对多种慢性肾脏病的治疗有效,他克莫司治疗原发性膜性肾病(IMN)缓解率较环磷酰胺(CTX)方案提高;可有效安全治疗微小病变型肾病(MCD);在难治性局灶性节段性肾小球硬化(FSGS) 及难治性狼疮肾炎(LN)治疗中可降低蛋白尿,临床缓解率高,耐受性好;治疗激素抵抗型儿童肾病综合征疗效更好且安全。 改善全球肾脏病预后( KDIGO)指南推荐他克莫司应用于IMN、MCD、FSGS、LN 和儿童肾病综合征治疗。 同时,他克莫司也可发生感染、震颤、失眠、血肌酐升高、高血糖、高血压和感觉异常等不良反应。 因此,在肾脏病的治疗中应注意合理、有效和安全的使用。

Tacrolimus, a novel immunosuppressant, can protect podocytes and reduce urinary protein. Recent studies show that tacrolimus has higher remission rate than cyclophosphamide (CTX) in treatment of idiopathic membranous nephropathy (IMN). And tacrolimus therapy can effectively and safety treat minimal change nephropathy (MCD). Tacrolimus can also reduce proteinuria in both refractory focal segmental glomerulosclerosis (FSGS) and refractory lupus nephritis (LN) with good clinical remission rate and tolerability. Besides, tacrolimus has better efficacy and safety in treatment of steroid-resistant children nephrotic syndrome (NS). KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend tacrolimus to be used in treatment of IMN, MCD, FSGS, LN, and children NS. However, there are some side effects of tacrolimus, including immunosuppression and infection, tremor, insomnia, elevated serum creatinine, high blood glucose, high blood pressure, and so on. Therefore, we should pay attention to the reasonable, effective and safe application of tacrolimus in treatment of kidney diseases.

1
Li X, Li H, Chen J, et al. Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome[J]. Nephrol Dial Transplant,2008,23(6):1919-1925.
2
Li H, Shi X, Shen H, et al. Tacrolimus versus intravenous pulse cyclophosphamide therapy in Chinese adults with steroid-resistant idiopathic minimal change nephropathy: a multicenter, open-label,nonrandomized cohort trial [J]. Clin Ther,2012,34(5):1112-1120.
3
Kidney Disease: Improving Global Outcomes ( KDIGO )Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis [J]. Kidney Int Suppl, 2012, 2(2): 139-174.
4
He L, Peng Y, Liu H, et al. Treatment of idiopathic membranous nephropathy with combination of low-dose tacrolimus and corticosteroids [J]. J Nephrol,2013,26(3):564-571.
5
Xie G, Xu J, Ye C, et al. Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults [J]. PLoS One,2012,7(9): e44330.
6
Praga M, Barrio V, Juárez GF, et al. Tacrolimus monotherapy in membranous nephropathy:a randomized controlled trial[J]. Kidney Int,2007,71(9):924-930.
7
Chen W, Liu Q, Liao Y, et al. Outcomes of tacrolimus therapy in adults with refractory membranous nephrotic syndrome: a prospective, multicenter clinical trial [J]. Am J Med Sci, 2013,345(2):81-87.
8
Duncan N, Dhaygude A, Owen J, et al. Treatment of focal and segmental glomerulosclerosis in adults with tacrolimus monotherapy[J]. Nephrol Dial Transplant,2004,19(12):3062-3067.
9
Ren H,Shen P,Li X,et al. Tacrolimus versus cyclophosphamide in steroid-dependentorsteroid-resistantfocalsegmental glomerulosclerosis: a randomized controlled trial [ J]. Am J Nephrol,2013,37(1):84-90.
10
Segarra A,Vila J,Pou L,et al. Combined therapy of tacrolimus and corticosteroids in cyclosporin-resistant or -dependent idiopathic focal glomerulosclerosis: a preliminary uncontrolled study with prospective follow-up [J]. Nephrol Dial Transplant,2002,17(4):655-662.
11
Zhang Q,Shi SF, Zhu L,et al. Tacrolimus improves the proteinuria remission in patients with refractory IgA nephropathy [J]. Am J Nephrol,2012,35(4):312-320.
12
Wang S, Li X, Qu L, et al. Tacrolimus versus cyclophosphamide as treatment for diffuse proliferative or membranous lupus nephritis: a non-randomized prospective cohort study [J]. Lupus, 2012, 21(9):1025-1035.
13
Deng J, Huo D, Wu Q, et al. A meta-analysis of randomized controlledtrialscomparingtacrolimuswithintravenous cyclophosphamide in the induction treatment for lupus nephritis[J].Tohoku J Exp Med,2012,227(4):281-288.
14
Fei Y, Wu Q, Zhang W, et al. Low-dose tacrolimus in treating lupus nephritis refractory to cyclophosphamide: a prospective cohort study [J]. Clin Exp Rheumatol,2013,31(1):62-68.
15
Bhimma R, Adhikari M, Asharam K, et al. Management of steroidresistant focal segmental glomerulosclerosis in children using tacrolimus [J]. Am J Nephrol,2006,26(6):544-551.
16
Yang M, Li M, He W, et al. Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis[J]. Exp Ther Med,2014,7(6):1663-1670.
17
Gordon S, Denunzio T, Uy A. Success using tacrolimus in patients with proliferative and membranous lupus nephritis and refractory proteinuria [J]. Hawaii J Med Public Health, 2013, 72(9 Suppl 4):18-23.
18
Mok CC, To CH, Yu KL, et al. Combined low-dose mycophenolate mofetil and tacrolimus for lupus nephritis with suboptimal response to standard therapy: a 12-month prospective study. Lupus, 2013, 22(11):1135-1141.
19
Choudhry S, Bagga A, Hari P, et al. Efficacy and safety of tacrolimus versus cyclosporine in children with steroid-resistant nephrotic syndrome:a randomized controlled trial[J]. Am J Kidney Dis,2009,53(5):760-769.
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