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Infrequent tacrolimus-induced nephrotoxicity in French patients with steroid-dependent nephrotic syndrome

  • Jean Daniel Delbet
  • Bilal Aoun
  • David Buob
  • Jad Degheili
  • Isabelle Brocheriou
  • Tim UlinskiEmail author
Brief Report

Abstract

Background

Chronic nephrotoxicity with potentially irreversible lesions is a major concern regarding calcineurin inhibitor (CNI) treatment in children with severe forms of idiopathic nephrotic syndrome (INS).

Case-diagnosis/Treatment

We retrospectively included all children on CNI for steroid-dependent INS with a duration of CNI treatment of more than 1 year. Only patients in whom CNI could not be replaced by mycophenolate mofetil were included. All included patients underwent a kidney biopsy. All results were expressed as median and range. Twenty-one children (6 girls) were included. Age at disease onset was 49 (29–66) months and treatment duration on CNI was 30 (20–45) months. Age at kidney biopsy was 108 (78–170) months. Number of relapses was 7 (3–9) since disease onset. Serum creatinine level was transiently and moderately increased in two patients. Kidney biopsy revealed minimal change disease in 20/21 patients and focal segmental glomerulosclerosis in 1/21. Evidence for chronic CNI nephrotoxicity was found in one patient revealed by arteriolar hyalinosis and fibrosis in 50% of glomeruli.

Conclusions

CNI-induced chronic nephrotoxicity was infrequent. In patients who require long-term and/or high-dose CNI treatment, kidney biopsies might be useful to exclude chronic CNI-induced lesions.

Keywords

Idiopathic nephrotic syndrome Tacrolimus Children Nephrotoxicity Cyclosporine 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional ethics committee and written informed consent was from the parents or legal representatives and from the patients older than 12 years.

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Copyright information

© IPNA 2019

Authors and Affiliations

  1. 1.Department of Pediatric NephrologyArmand Trousseau Hospital, APHPParisFrance
  2. 2.University Pierre and Marie CurieParisFrance
  3. 3.Department of Paediatrics, Division of Pediatric NephrologyAmerican University of BeirutBeirutLebanon
  4. 4.Pathology DepartmentTenon Hospital, APHPParisFrance
  5. 5.Department of Surgery, Division of UrologyAmerican University of BeirutBeirutLebanon
  6. 6.DHU 2iB, Inflammation-ImmunotherapyParisFrance

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