目的　探讨他克莫司治疗肾病综合征导致急性肾衰竭的原因。方法　回顾分析2012年1月至2015年12月期 间因他克莫司治疗肾病综合征导致急性肾衰竭的3例患儿的临床资料。结果　3例患儿中男2例、女1例，年龄分别为3、 11和13岁。临床均符合肾病综合征（原发性、单纯型），1例为频复发、 2例为继发激素耐药型，肾脏病理均为微小病变。在 激素治疗基础上，加用他克莫司后出现急性肾衰竭，均发生于他克莫司治疗后4周内，且前1周内均有感染诱因，经停用 或减量他克莫司并对症、支持治疗，肾功能均于2周内恢复正常，其中2例继续应用他克莫司、 1例更换为环孢素A。随访 10~42个月， 3例患儿的肾功能均维持正常。结论　在他克莫司治疗儿童肾病综合征的开始4周内，如果合并感染，可能导 致可逆性的急性肾衰竭。

　Objective　To explore the causes of acute renal failure resulted from tacrolimus in the treatment of nephrotic syndrome. Method　The clinical data of acute renal failure caused by tacrolimus in treatment of nephrotic syndrome in 3 children during January 2012 and December 2015 were retrospectively analyzed. Results　There were 2 male and 1 female aged 3, 11， and 13 years respectively. Clinical manifestations were consistent with simple type of primary nephrotic syndrome. One child was frequently recurrent and another two were secondary steroid resistant. The renal pathology showed minimal changes. Acute renal failure occurred within 4 weeks after treatment with tacrolimus on the basis of hormone therapy in all patients who had infection within one week. Renal function recovered to normal within 2 weeks after discontinuation or reduction of tacrolimus combined with anti-infection and diuresis treatment. Two children continued with tacrolimus, but the other one was replaced with cyclosporin A. The renal function of all patients remained normal during the follow-up for 10-42 months. Conclusion　In the first 4 weeks of tacrolimus therapy in children with nephrotic syndrome, infection may lead to reversible acute renal failure.