The optimal blood concentration range of tacrolimus for the treatment of nephrotic syndrome in children
Objective To investigate the optimal blood concentration range of tacrolimus(TAC)for the treatment of nephrotic syndrome(NS)in children.Methods Children with NS admitted to the Department of Nephrology and Immunology of Hebei Children's Hospital from January 2021 to December 2023 were retrospectively selected as study subjects.They were divided into the effective group and the ineffective group according to whether the treatment was effective or not,and the TAC threshold for effective treatment was determined by using the receiver operator characteristic(ROC)curve.The children with NS were divided into a low concentration group(＜3 ng/mL),a medium concentration group(3-5 ng/mL)and a target concentration group(5-10 ng/mL)according to the TAC concentration,and the relationships between the TAC concentration and the clinical efficacy and adverse reactions was analyzed.Results A total of 160 children were enrolled in the study.The numbers of complete remission(CR),partial remission(PR),and null remission(NR)cases of NS children were 91,37,and 32,respectively,and the treatment was effective in 128 cases(80％).The ROC curve analysis results showed that the area under the ROC curve(95％CI),sensitivity,specificity,and threshold of the mean trough concentration of TAC for predicting the efficacy of the treatment were 0.779(0.704,0.853),62.5％,84.45％,and 3.33 ng/mL,respectively.In terms of clinical efficacy,CR and PR were lower and NR was higher in the low concentration group compared with the target concentration group(P＜0.05);whereas,CR was lower and PR was higher in the medium concentration group(P＜0.05),and the difference in NR was not statistically significant(P＞0.05).In terms of different hormone-responsive phenotypes of NS,the CR of the low concentration group was lower(P＜0.05),while there was no significant difference in CR and PR between the medium concentration group and the target concentration group(P＞0.05).As for the different pathological types of NS,CR was lower in the low concentration group when compared with the target concentration group or medium concentration group(P＜0.05);while the differences in CR and PR between the medium concentration group and the target concentration group were not statistically significant(P＞0.05).Regarding adverse reactions,the incidence of limb tremor and abnormal blood glucose was significantly higher in the target concentration group than in the other two groups(P＜0.05).In addition,the differences in serious infections and hypertension among the three groups were not statistically significant(P＞0.05).Conclusion When TAC is used to treat NS in children,the recommended TAC concentration range is 3-5 ng/mL.
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