他克莫司在肾脏病中的合理应用

Reasonable application of tacrolimus in renal diseases

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 taeroiimus 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 glomeruloselerosis （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 nephrotie 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 taerolimus in treatment of kidney diseases.