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Objectives To describe patients with lupus nephritis who received tacrolimus (TAC) as part of combination therapy due to prior treatment ineffectiveness.Methods Study included 11 female patients with systemic lupus erythematosus (SLE), with a median age of 33 years (range 32-38) and a duration of 96 months (range 36-192) of SLE ( table 1). TAC was added to their regimen, with a target plasma level at 12 hours of 4-6 ug/L.Results Before TAC, the duration of lupus nephritis (LN) was 46 (in the range of 12-162) months. The drug therapy performed prior to the TAC is shown in table 1. A kidney biopsy determined LN as 3/4/5/6 in 4/4/2/1 patients. TAC treatment lasted more than one year in four patients, six months or more in four patients, and four months in three patients. The average number of exacerbations of kidney disease before TAC was 2 [2-3]. All patients received hydroxychloroquine from the very beginning of SLE. None of the patients developed progressive chronic kidney disease, with the exception of one patient who had it before TAC and persisted after kidney transplantation. There were no relapses after the start of TAC. An extrarenal exacerbation of SLE was reported in a patient who had been taking TAC for 12 months for subacute SLE and had a complete renal response. Anifrolumab was added to her. A complete renal response had 4 of the 11 patients, while 5 had a partial one. The activity of SLE, indicators of renal function before and during TAC therapy are presented in table 2.Abstract PO:10:257 Table 1–2Conclusions Adding TAC to existing immunosuppressive therapy led to further decreases in LN activity in patients whose proteinuria did not improve with previous treatments.