他克莫司治疗儿童难治性肾病综合征临床分析

李志娟1 ，包瑛1，陈国强2

（1.西安市儿童医院肾脏科，陕西 西安，710003；2.陕西省西北妇女儿童医院儿内三科，陕西 西安，710061）

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摘要：

目的 通过分析5例儿童难治性肾病综合征的临床资料，重复肾活检结果，了解他克莫司治疗儿童难治性肾病综合征的疗效及肾脏毒性。方法 回顾性分析在我科住院确诊为难治性肾病综合征、给予他克莫司治疗，且行重复肾活检的5例患儿的临床资料，了解其临床、肾脏病理改变及转归情况。结果 5例患儿中2例为激素耐药，2例为频复发，1例为激素依赖，口服他克莫司22～127 d完全缓解。5例患儿均未见典型小动脉病变，他克莫司减量后均有复发。结论 他克莫司是治疗儿童难治性肾病综合征强有效的免疫抑制剂，减量后易复发，在治疗过程中需密切监测毒副作用，必要时需重复肾活检了解肾脏病理有无转型及他克莫司的肾脏毒性。

关键词：难治性肾病综合征；他克莫司；儿童；重复肾活检

中图分类号：R726.9文献标志码：A文章编号：2096-1413(2017)22-0014-04

Clinical analysis of children with refractory nephrotic syndrome treatd with tacrolimus
LI Zhi-juan 1, BAO Ying 1, CHEN Guo-qiang 2
(1. Department of Kidney, Xi``an Children``s Hospital, Xi``an 710003; 2. the Third Department of Internal Medicine, Northwest Women

and Children Hospital, Xi``an 710061, China)

ABSTRACT: Objective To analyze the clinical data and repeat renel biopsy pathology of five children with refractory nephrotic syndrome treatd with tacrolimus, in order to understand the curative effect and renal toxicity of tacrolimus. Methods The clinical data of 5 children with refractory nephrotic syndrome treatd with tacrolimus and underwent repeated renal biopsy were retrospectively analyzed, and the clinical and renal pathological changes and the outcomes were studied. Results In the 5 cases, 2 cases were steroid-resistant nephrotic syndrome, 2 cases were frequently relaps, and 1 case was steroid-dependent nephrotic syndrome, and all the children had complete remission after oral tacrdimus for 22-127 days. All the children had no typical arteriolar lesion. Five children had recurrence after reduction of tacrolimus. Conclusion Tacrolimus is strong effective immune inhibitor for children with refractory nephrotic syndrome, but it is easy to relapse. Side effects are needed to be monitored, sometimes repeated renal biopsy is needed in order to understand the change of the renal pathology and the renal toxicity of tacrolimus.
KEYWORDS: refractory nephrotic syndrome; tacrolimus; children; repeated renal biopsy

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