Study on the risk factors and predictive model for acute kidney injury during tacrolimus treatment for pediatric steroid-resistant nephrotic syndrome
- VernacularTitle:他克莫司治疗儿童激素耐药型肾病综合征期间出现急性肾损伤的危险因素及预测模型研究
- Author:
Yuqing LIU
1
;
Lei ZHU
2
;
Zhaohuan HAN
1
;
Lei ZHAO
3
Author Information
1. Dept. of Pharmacy，Xuzhou Children’s Hospital，Jiangsu Xuzhou 221006，China
2. Dept. of Critical Care Medicine，Xuzhou Children’s Hospital，Jiangsu Xuzhou 221006，China
3. Dept. of Pharmacy，the Affiliated Hospital of Xuzhou Medical University，Jiangsu Xuzhou 221000，China
- Publication Type:Journal Article
- Keywords:
tacrolimus;
steroid-resistant nephrotic syndrome;
children;
acute kidney injury;
risk factors;
risk prediction model
- From:
China Pharmacy
2026;37(1):66-71
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To explore the risk factors for acute kidney injury （AKI） in children with steroid-resistant nephrotic syndrome （SRNS） during tacrolimus treatment and construct a predictive model. METHODS A retrospective selection was made of 155 children diagnosed with SRNS and treated with tacrolimus at Xuzhou Children’s Hospital from January 1， 2022， to December 31， 2023， serving as the study subjects. Various clinical data of the children were collected by reviewing the medical record system. Children who developed AKI during medication were assigned to the AKI group （n＝26）， and those who did not develop AKI were assigned to the control group （n＝129）. Univariate and multivariate Logistic regression analyses were used to screen independent risk factors. A clinical predictive model was constructed based on significant variables， and nomogram， calibration curve， receiver operator characteristic curve， and decision curve were drawn to evaluate the model’s performance. RESULTS Univariate analysis showed that blood urea nitrogen （BUN）， serum creatinine （Scr）， estimated glomerular filtration rate （eGFR）， the maximum trough concentration （cmin） of tacrolimus， CYP3A5*3/*3 genotype， concurrent infection， concurrent hypertension， and the use of non-steroidal anti-inflammatory drugs were influencing factors for AKI in children with SRNS during tacrolimus treatment （P＜0.05）. Multivariate Logistic regression analysis revealed that BUN≥9.58 mmol/L， Scr≥125 μmol/L， eGFR＜37 mL/（min·1.73 m2）， tacrolimus maximum cmin≥11.26 ng/mL，CYP3A5*3/*3 genotype， concurrent infection， and concurrent hypertension were independent risk factors for AKI in children with SRNS during tacrolimus treatment （P＜0.05）. The constructed clinical predictive model had an area under the curve of 0.747， showing good agreement between predicted and actual AKI occurrence and demonstrating favorable clinical net benefit in predicting AKI in children. CONCLUSIONS Impaired baseline renal function （elevated BUN， elevated Scr， and decreased eGFR）， elevated maximum cmin of tacrolimus， CYP3A5*3/*3 genotype， concurrent infection， and hypertension during treatment are independent risk factors for AKI in children with SRNS during tacrolimus treatment. The established clinical predictive model provides a scientific basis for implementing risk stratification management.
