Tacrolimus versus Cyclophosphamide and Mycophenolate Mofetil in Pediatric IgA Vasculitis Nephritis: Superior Early Remission and Long-Term Renal Outcomes in a Large Single-Center Cohort

IgA vasculitis nephritis (IgAVN) is a frequent form of secondary glomerular disease in childhood. Although consensus documents generally acknowledge the therapeutic value of cyclophosphamide (CYC), guidance regarding tacrolimus (TAC) and mycophenolate mofetil (MMF) remains variable. Existing data indicate that TAC can work safely and effectively in IgAVN, but the long-term influence of different immunosuppressants is still not clearly defined. This study was designed to compare TAC, CYC, and MMF—each given with glucocorticoids—in terms of their therapeutic effects and long-term renal outcomes in pediatric IgAVN. Children diagnosed with grade II–V IgAVN on renal biopsy at Tongji Hospital from November 2011 to October 2021 were reviewed retrospectively. Clinical features, pathology, treatment information, and follow-up records were evaluated.
A total of 422 cases met the inclusion criteria. Of these, 108 received oral TAC plus glucocorticoids, 143 were treated with intravenous CYC plus glucocorticoids, and 171 received oral MMF with glucocorticoids. Complete remission (CR) was higher with TAC (25.9%/44.3%) compared with CYC (16.1%/36.4%) at 3 and 6 months. TAC produced a greater drop in proteinuria at 1, 3, and 6 months than both CYC and MMF. Total adverse events occurred less frequently with TAC and MMF (60.2%, 65.7%) than with CYC (84.4%). TAC and MMF also showed better renal status (grade A and B) and a reduced recurrence rate (17.9%, 23.9% vs 41.8%) compared with CYC. TAC rapidly reduces urinary protein levels, promotes complete renal remission, and results in fewer complications. TAC and MMF appear to offer more favorable long-term kidney outcomes.