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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 PLoS+One
2017 ; 12
(11
): e0188375
Nephropedia Template TP
gab.com Text
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English Wikipedia
Short-term anti-proteinuric effect of tacrolimus is not related to preservation
of the glomerular filtration rate in IgA nephropathy: A 5-year follow-up study
#MMPMID29155873
Yu MY
; Kim YC
; Koo HS
; Chin HJ
PLoS One
2017[]; 12
(11
): e0188375
PMID29155873
show ga
BACKGROUND: The immunosuppressive drug tacrolimus has the short-term effect of
reducing proteinuria in patients with immunoglobulin A nephropathy (IgAN). Our
study investigated the effects on proteinuria and kidney function after
discontinuation of tacrolimus. METHODS: Patients with biopsy-proven IgAN were
included in the study and randomly divided into two treatment groups. There was a
corresponding control group for each treatment group. The first group included
patients treated with tacrolimus (Tac vs non-Tac group) and the second group
included patients with a renin angiotensin system blocker (RASi vs non-RASi
group). The Tac group received treatment for up to 16 weeks, with the
administration of tacrolimus being ceased at the final visit (trial phase). We
tracked the patients at 12, 24, 52, and 240 weeks (observational phase). The
primary outcomes examined were the percentage change (from the trial phase to the
observational phase) of time-averaged proteinuria (TA-proteinuria; g/g creatinine
[cr]) and the estimated glomerular filtration rate (eGFR). Time-averaged
proteinuria was defined as the average of urine protein to creatinine ratio
(UPCR), measured every 3 months during both the trial and observational phases of
the study. RESULTS: A significant reduction in UPCR was observed in the Tac group
compared to non-Tac group at the 4 and 8 week visits during the trial phase (p =
0.023 and p = 0.003, respectively). However, the difference between the Tac group
and non-Tac group was not evident in the other review periods, estimated by
linear mixed effect model. The percentage change in TA-proteinuria was greater in
the Tac group than that in the corresponding control group (116 ± 96% vs. 63 ±
239%, p = 0.004). Therefore, during the observational phase, TA-proteinuria was
not significantly different between the Tac group and the non-Tac group (1.150 ±
0.733 g/g cr vs. 1.455 ± 2.017 g/g cr, p = 0.775). The levels of eGFR throughout
the observational phase were not significantly different between the two groups.
Furthermore, the mean rate of eGFR change throughout both phases of the study was
-6.4 ± 5.9 mL/min/1.73 m2/year in the non-Tac group and -5.4 ± 7.9 mL/min/1.73
m2/year in the Tac group (p = 0.988). CONCLUSION: The anti-proteinuric effect of
tacrolimus was promptly reversed 3 months after discontinuing the drug. The use
of tacrolimus for a short period of time for patients with IgAN temporarily
reduces proteinuria, but the data showed no long-term efficacy regarding
proteinuria reduction and improvement of renal function.