Tacrolimus in resistant primary membranous nephropathy - a report of 3 cases

AIM: To study the efficacy and safety of tacrolimus in primary membranous nephropathy. METHOD: We describe 3 patients with primary membranous nephropathy who were either resistant to or could not tolerate steroid with or without cytotoxic agents. They were treated with tacrolimus 0.2 mg/kg/day for 6 months. The dosage of tacrolimus was adjusted to keep a whole blood tacrolimus level of 5-10 ng/ml. RESULTS: One patient had almost complete disappearance of proteinuria while the other 2 had at least 50% reduction in proteinuria. Proteinuria increased again in 2 of the patients after tacrolimus was stopped, but in neither of them proteinuria returned to the pretreatment level 6 months after tacrolimus was stopped. CONCLUSION: We conclude that tacrolimus may have a modest efficacy in the treatment of resistant membranous nephropathy.