Calcineurin inhibitors in the treatment of primary nephrotic syndrome in children

In pediatric nephrology, idiopathic nephrotic syndrome is the most common glomerular disease. It is now known that about 70% of children with idiopathic nephrotic syndrome develop relapses of the disease, while about 10% of patients are resistant to steroid therapy. In recent decades, calcineurin inhibitors, cyclosporine A and tacrolimus have been used in the treatment of steroid-resistant and steroid-dependent nephrotic syndrome as the first line of immunosuppressive therapy, forming the basis of the treatment of nephrotic syndrome, with more than 70% of patients achieving complete or partial remission of the disease with a favorable long-term prognosis for kidney function. This review discusses the mechanisms of calcineurin inhibitors action and their advantages and disadvantages. Varied therapeutic responses to calcineurin inhibitors prompt further investigation of population pharmacokinetics and pharmacodynamics in order to subsequently consider and possibly develop personalized treatment regimens through the use of therapeutic drug monitoring.