Efficacy of tacrolimus in steroid dependent and steroid resistant childhood nephrotic syndrome - A retrospective study

Introduction: Nephrotic syndrome is a common renal disease in children. Majority of the children usually responds to steroids without any long term effects on kidney function. However about 10-20% of children are usually steroid dependent or steroid resistant and require multiple additional immunosuppressive medications such as cyclophosphamide, cyclosporine, tacrolimus, mycophenolate mofetil and Rituximab. All these drugs are associated with specific adverse effects and lack of response to the drug can result in slow decline in renal function and development of end stage renal disease. Material and Methods:A retrospective study was done to determine the efficacy of tacrolimus in steroid dependent and steroid resistant nephrotic syndrome (SDNS and SRNS). 40 children with SDNS and SRNS were included in the study. All patients were observed for complete remission, partial remission, decline in renal function and adverse effects of the drug. Results:Study included 40 patients of SDNS (n=19) and SRNS (n=21) with 18 boys and 22 girls with mesangioproliferative glomerulonephritis (MPGN) in 1. Complete remission was achieved in 14 children in SDNS group and 11 children in SRNS group. 3 children in SDNS group and 4 children in SRNS group did not achieve any remission despite treatment for 6 to 12 months. Adverse effects of the drugs included infections, tremors and hyperglycemia and were similar in both the groups.mean duration of follow up of 24 months. Renal biopsy of patients showed minimal change disease (MCD) in 23, focal segmental glomerulosclerosis (FSGS) in 13, IgM nephropathy in 3 and Conclusion: Tacrolimus is efficacious in inducing and maintaining remission in children with steroid dependent and steroid resistant nephrotic syndrome with minimal adverse effects.