Tacrolimus Therapy Among Steroid-Resistant Nephrotic Syndrome Children: A Preliminary Study in West Java, Indonesia

Ahmedz Widiasta, Kurnia Wahyudi, Dedi Rachmadi

Abstract


Objective: To explore the outcomes of Tac therapy for Steroid-Resistant Nephrotic Syndrome (SRNS) and its implication in reducing the number of CKD events.

Methods: An open, prospective, cohort study was conducted at a tertiary hospital in Bandung, West Java, Indonesia. Children (age 1–18 years old) with steroid and cyclophosphamide resistant nephrotic syndrome were enrolled in this study. Blood pressure, urinary protein, serum ureum, and creatinine levels were measured every month, Tac and soluble urokinase plasminogen activator receptor (supaR) levels were assessed at the 0, third, and sixth months.

Results: Ten of fifteen subjects enrolled in this study got better within 3–6 months with a trend of decreasing suPAR level and proteinuria, as well as stable blood pressure and serum creatinine and ureum level. During treatment, no side effects of the subjects were found with the Tac level maintain safely.

Conclusion: Tac is an effective and safe agent in treating SRNS, especially for those do not respond well to an alkylating agent.


Keywords


Developing-country, soluble urokinase plasminogen activator receptor, steroid-resistant nephrotic syndrome, tacrolimus

Full Text:

PDF

References


  1. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1–S276. doi:10.1016/j.kint.2021.05.021
  2. Widiasta A, Wahyudi K, Nugrahapraja H, Sribudiani Y, Rachmadi D. The unique difference between serum level of soluble urokinase plasminogen activator receptor (suPAR) in steroid-resistant nephrotic syndrome children treated with an alkylating agent and calcineurin inhibitors. J Compr Pediatr. 2021;In Press(In Press):e109912. doi:10.5812/compreped.109912
  3. Fogo AB. Causes and pathogenesis of focal segmental glomerulosclerosis. Nat Rev Nephrol. 2015;11(2):76–87. doi:10.1038/nrneph.2014.216
  4. Malaga-Dieguez L, Bouhassira D, Gipson D, Trachtman H. Novel therapies for FSGS: preclinical and clinical studies. Adv Chronic Kidney Dis. 2015;22(2):e1–e6. doi:10.1053/j.ackd.2014.10.001
  5. Butani L, Ramsamooj R. Experience with tacrolimus in children with steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2009;24(8):1517–23. doi:10.1007/s00467-009-1220-z
  6. Hoefele J, Beck BB, Weber LT, Brinkkötter P. Steroid-resistent nephrotic syndrome. Medizinische Genet. 2018;30:410–21. doi:10.1007/s11825-018-0215-1
  7. Li X, Li H, Chen J, He Q, Lv R, Lin W, et al. Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome. Nephrol Dial Transplant. 2008;23(6):1919–25. doi:10.1093/ndt/gfm637
  8. Moghtaderi M. Continuous Renal Replacement Therapy (CRRT) in Patients with COVID-19 Infection. 2020;8(2):4–7.
  9. Mousa SO, Saleh SM, Aly HM, Amin MH. Evaluation of serum soluble urokinase plasminogen activator receptor as a marker for steroid-responsiveness in children with primary nephrotic syndrome. Saudi J Kidney Dis Transpl. 2018;29(2):290–96. doi:10.4103/1319-2442.229266
  10. Stone H, Magella B, Bennett MR. The Search for Biomarkers to Aid in Diagnosis, Differentiation, and Prognosis of Childhood Idiopathic Nephrotic Syndrome. Front Pediatr. 2019;7(October):1–12. doi:10.3389/fped.2019.00404
  11. Wada T, Nangaku M. A circulating permeability factor in focal segmental glomerulosclerosis: The hunt continues. Clin Kidney J. 2015;8(6):708–15. doi:10.1093/ckj/sfv090
  12. Winnicki W, Sunder-Plassmann G, Sengölge G, et al. Diagnostic and prognostic value of soluble urokinase-type plasminogen activator receptor (suPAR) in focal segmental glomerulosclerosis and impact of detection method. Sci Rep. 2019;9(1):2–10. doi:10.1038/s41598-019-50405-8
  13. Widiasta A, Wahyudi K, Nugrahapraja H, Sribudiani Y, Rachmadi D. The unique difference between serum level of soluble urokinase plasminogen activator receptor (suPAR) in steroid-resistant nephrotic syndrome children treated with an alkylating agent and calcineurin inhibitors. J Compr Pediatr. 2021;In Press(In Press). doi:10.5812/compreped.109912
  14. Falkiewicz K, Kamińska D, Nahaczewska W, et al. Renal function and tubular phosphate handling in long-term cyclosporine- and tacrolimus-based immunosuppression in kidney transplantation. Transplant Proc. 2006;38(1):119–22. doi:10.1016/j.transproceed.2005.12.083
  15. Lim BJ, Yang JW, Do WS, Fogo AB. Pathogenesis of focal segmental glomerulosclerosis. J Pathol Transl Med. 2016;50(6):405–10. doi:10.4132/jptm.2016.09.21
  16. Faul C, Donnelly M, Merscher-Gomez S, Chang YH, Franz S, Delfgaauw J, et al. The actin cytoskeleton of kidney podocytes is a direct target of the antiproteinuric effect of cyclosporine. A. Nat Med. 2008;14(9):931–8. doi:10.1038/nm.1857
  17. Widiasta A, Wahyudi K, Sribudiani Y, Rachmadi D. The level of transforming growth factor beta as a possible predictor of cyclophosphamide response in children with steroid-resistant nephrotic syndrome. BioMedicine. 2021;11(3):67–75. doi:10.37796/2211-8039.1205
  18. Wei C, El Hindi S, Li J, Fornoni A, Goes N, Sageshima J, et al. Circulating urokinase receptor as a cause of focal segmental glomerulosclerosis. Nat Med. 2011;17(8):952–60. doi:10.1038/nm.2411
  19. Alachkar N, Li J, Matar D, Vujjini V, Alasfar S, Tracy M, et al. Monitoring suPAR levels in post-kidney transplant focal segmental glomerulosclerosis treated with therapeutic plasma exchange and rituximab. BMC Nephrol. 2018;19(1):361–8.
  20. Gulati A, Sinha A, Gupta A, Kanitkar M, Sreenivas V, Sharma J, et al. Treatment with tacrolimus and prednisolone is preferable to intravenous cyclophosphamide as the initial therapy for children with steroid-resistant nephrotic syndrome. Kidney Int. 2012;82(10):1130–5. doi:10.1038/ki.2012.238
  21. Widiasta A, Wahyudi K, Sribudiani Y, Rachmadi D. The level of transforming growth factor-β as a possible predictor of cyclophosphamide response in children with steroid-resistant nephrotic syndrome. BioMedicine. 2021;11(3):68–75. doi:10.37796/2211-8039.1205




DOI: https://doi.org/10.15850/ijihs.v12.n2.3663

Article Metrics

Abstract view : 88 times
PDF - 44 times


 

This Journal indexed by

                   

 


Creative Commons License
IJIHS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License



View My Stats