Abstract: Objective  A retrospective cohort study was conducted to evaluate the efficacy and safety of cyclosporine combined with prednisone(CsA/GC) in tacrolimus combined with prednisone(TAC/GC) in the treatment of idiopathic membranous nephropathy(IMN) with nephrotic syndrome.
Methods   A total of 139 patients with IMN patients with nephrotic syndrome confirmed by renal biopsy were enrolled in this study. Seventy eight patients were in the CsA/GC group and sixty one belong TAC/GC group. The therapeutic effect and adverse events in the two groups were assessed.
Results   The median follow-up time was(13.5 vs 16.0) months in the CsA/GC group and TAC/GC group. Two cases(2.6%) in CsA/GC group were lost to follow-up. At the end of follow-up, the overall remission rates were similar between two groups(89.7% vs 85.4%, P＞0.05). Compared with the CsA/GC group, the TAC/GC group needed less time to achieve partial remission and larger doses to maintain remission was significantly lower［(6.0 vs 8.5) months and (21.3% vs 38.5%), both P＜0.05］, respectively. No gingival hyperplasia(0.0% vs 7.7%, P＜0.05). The relapse rates were similar between two groups(19.2% vs 26.2%, P＞0.05). The incidence of renal damage in two groups was 25.6% and 24.6%, and there were no statistically significant differences between two groups in infection of requiring hospitalization, and liver enzyme elevation(all P＞0.05). Two cases of drug diabetes mellitus in TAC/GC group. There were 2 cases of deep vein thrombosis in CsA/GC group.
Conclusion  Both low dose cyclosporine and tacrolimus can effectively treat IMN. Tacrolimus had a faster partial remission, a lower proportion of patients who needed a larger dose to maintain remission, and no gingival hyperplasia. But its effect on glucose metabolism should cause clinical concern.

Key words: nephrotic syndrome, prednisone, drug toxicity