Objective      To investigate the clinical efficacy and safety of low-dose tacrolimus (TAC) in combination of glucocorticoid in treatment of IgA nephropathy with moderate proteinuria. MethodsA total of 64 patients IgA nephropathy with moderate proteinuria (1.0～3.5 g per 24 h) diagnosed by renal biopsy and clinical data who admitted in our department from January 2012 to January 2015 were enrolled in this study. According to therapeutic schemes

the patients were divided into low-dose TAC+glucocorticoid group [n=34

TAC 0.02～0.05 mg/(kg·d)

orally twice per day

with trough concentration being maintained at 3～5 ng/mL; oral administration of prednisone with an initial dose of 0.5 mg/(kg·d) and maximal dose not exceeding 40 mg/d] and hormone group [n=30

oral administration of prednisone with an initial dose of 1 mg/(kg·d) and maximal dose not exceeding 70 mg/d]. The clinical data before treatment and at 1

3 and 6 months after treatment were collected and analyzed

and their adverse reactions were also recorded. The 24-hour urinary protein

serum creatinine (Scr) and serum albumin (ALB) were selected as primary endpoints. ResultsThere were no significant differences between 2 groups in their clinical baseline data (P0.05). The 24-hour urinary protein was obviously decreased while ALB increased in both 2 groups in 6 months after treatment (P0.05)

and the reduction was more notably in the low-dose TAC+glucocorticoid group at 1

3 and 6 months after treatment than the hormone group (P0.05). No statistically differences were seen in complete remission rate and total effective rate between the 2 groups at each time point (P0.05). As for adverse reactions

in the monitoring of leukocyte

hemoglobin and platelet

no phenomenon of bone marrow suppression and infection was observed in the low-dose TAC group. There were 4 cases of blood glucose elevation

3 cases of liver function impairment

1 case of gastrointestinal reaction and 1 case of recurrent oral ulcer occurred in the low-dose TAC+glucocorticoid group. But for the hormone groups

the numbers of cases were increased to 5

4 and 2 cases respectively. Though there was no case of recurrent oral ulcer in the latter group

no statistical difference was seen between the 2 groups (P0.05). Both groups had no significant difference in Scr level and eGFR in 6 months after treatment compared with the values before treatment (P0.05). Conclusion      In the treatment of IgA nephropathy with moderate proteinuria

low-dose TAC+glucocorticoid is more efficiently in reduction of urinary protein than simple use of enough hormones

and has no effect on the increase of side effects. But it shows no benefits in higher clinical complete remission rate and total effective rate.