Changes in 24h urinary protein, serum albumin, serum creatinine of patients with membranous nephropathy in treatment with tacrolimus

CHEN Li; JI Zongwen; SUN Baoguang

doi:10.3969/j.issn.1671-6450.2016.12.007

Abstract：Objective To observe the effect of tacrolimus in the treatment of membranous nephropathy and its effect on serum creatinine, serum albumin, 24 h urinary protein and so on.Methods Seventy-two cases of patients with membra-nous nephropathy were selected , which were treated in hospital from October 2013 to October 2015 , and were divided into the observation group (36 cases) and the control group (36 cases).The patients of two groups were all treated with low protein , high calorie, high vitamin diet, oral amino acid, while the combination of angiotensin Ⅱreceptor blockers, angiotensin con-verting enzyme inhibitors , low molecular weight heparin and other conventional therapy .The patients of control group were treated with cyclophosphamide for injection (800-1000 mg dissolved in 250 ml 0.9% sodium chloride solution for intrave-nous infusion, 1 time /month, continuous treatment for 6 months).The patients of observation group were treated with ta-crolimus (initial dose of 0.1 mg· kg-1· d-1), 2 times/d, take 1h before meal, continuous application of six months .Inef-fective withdrawal, achieved complete remission or partial remission extended for 3 months.Detect blood concentration for 1 and 2 weeks of medication , after that, detection for 1 time /month, according to blood concentration of tacrolimus , dose were adjusted to 4-10ng /ml, then maintain 3-6ng /ml until complete remission.The patients of two groups were all treated with prednisolone tablets (0.5mg· kg-1· d-1 orally for 6 months of treatment).Compare the clinical efficacy, adverse reac-tions and changes of the levels of serum creatinine , blood glucose, serum albumin, lipids, and 24h urine protein of two groups.Results The total effective rate of observation group was higher than the control group (94 6.4% vs.77.8% χ2 =4.181, P =0.041);compared with before treatment , after treatment 2 groups of patients with serum creatinine and serum al-bumin were significantly increased , blood glucose, 24h urinary protein, total cholesterol and triglyceride levels were signifi-cantly lower (control group:t =5.253, t =3.567, t =1.975, t =16.374, t =6.529, t =15.380, P <0.05;observation group:t =9.119, t =5.433, t =4.104, t =22.871, t =9.121, t =18.197;); after treatment in observation group im-proved significantly better than the control group ( t =3.106, t =1.685, t =2.285, t =11.265, t =2.311, t =3.582, P <0.05);serum creatinine increase, diarrhea, hypertension, pulmonary infection, alopecia, leukopenia and other adverse reactions during treatment in 2 groups were improved after symptomatic treatment;the adverse reactions of 2 groups were com-pared, the difference was not statistically significant (χ2 =0.974,χ2 =0.564,χ2 =2.839,χ2 =2.885,χ2 =0.974,χ2 =2.839, P >0.05).Conclusion Tacrolimus in the treatment of membranous nephropathy is accurate , it can effectively im-prove serum creatinine, albumin levels, significantly reduce 24h urinary protein, blood lipids, blood glucose levels, safe and reliable, worthy of clinical application .