CLINICAL IMMUNOLOGY
Levamisole therapy in children with frequently relapsing and steroid-dependent nephrotic syndrome: a single-center experience
Submission date: 2016-07-04
Final revision date: 2016-08-07
Acceptance date: 2016-08-18
Publication date: 2016-10-25
Cent Eur J Immunol 2016;41(3):243-247
KEYWORDS
ABSTRACT
Introduction: Numerous studies suggest that levamisole, an antihelmintic agent with an immunomodulatory effect, reduces the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome (FRNS/SDNS). The aim of the study was to present a single center’s experience in treatment of FRNS and SDNS with levamisole.
Material and methods: Among 72 children with FRNS/SDNS treated in our department with levamisole in the years 1984-2011 we studied in detail 53 patients (mean age: 6.5 ±3.0 years), in whom the medication was administered for at least 6 months. In these 53 patients we evaluated: the course of the disease before levamisole, the renal biopsy result, medications used, prednisone dose on levamisole initiation, duration of levamisole treatment, time to first relapse and number of relapses on levamisole, and levamisole side effects.
Results: The duration of nephrotic syndrome was 3.4 ±2.9 years, and the number of relapses before levamisole treatment was 6.0 ±3.4. The dose of prednisone on initiation of levamisole treatment was 1.2 ±0.6 mg/kg/24 h, and the duration of levamisole treatment was 15.0 ±7.3 months. During levamisole treatment proteinuria relapsed in 34/53 (64.2%) children, and the time to first relapse was 8.8 ±8.1 months. During levamisole therapy relapses of the disease decreased significantly (2.7 ±2.0 vs. 1.8 ±2.1 relapses/year, p = 0.02). Time to first relapse correlated with total number of relapses (R = –0.59, p < 0.001) and number of relapses in one year during levamisole treatment (R = –0.60, p < 0.001).
Conclusions: Levamisole is effective in reducing the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome. Early relapse of proteinuria on levamisole treatment in children with FRNS/SDNS suggests low efficacy of further treatment.
Material and methods: Among 72 children with FRNS/SDNS treated in our department with levamisole in the years 1984-2011 we studied in detail 53 patients (mean age: 6.5 ±3.0 years), in whom the medication was administered for at least 6 months. In these 53 patients we evaluated: the course of the disease before levamisole, the renal biopsy result, medications used, prednisone dose on levamisole initiation, duration of levamisole treatment, time to first relapse and number of relapses on levamisole, and levamisole side effects.
Results: The duration of nephrotic syndrome was 3.4 ±2.9 years, and the number of relapses before levamisole treatment was 6.0 ±3.4. The dose of prednisone on initiation of levamisole treatment was 1.2 ±0.6 mg/kg/24 h, and the duration of levamisole treatment was 15.0 ±7.3 months. During levamisole treatment proteinuria relapsed in 34/53 (64.2%) children, and the time to first relapse was 8.8 ±8.1 months. During levamisole therapy relapses of the disease decreased significantly (2.7 ±2.0 vs. 1.8 ±2.1 relapses/year, p = 0.02). Time to first relapse correlated with total number of relapses (R = –0.59, p < 0.001) and number of relapses in one year during levamisole treatment (R = –0.60, p < 0.001).
Conclusions: Levamisole is effective in reducing the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome. Early relapse of proteinuria on levamisole treatment in children with FRNS/SDNS suggests low efficacy of further treatment.
REFERENCES (26)
1.
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group (2012): KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int Suppl 2: 139-274.
2.
Lombel RM, Hodson EM, Gipson DS (2013): Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDIGO. Pediatr Nephrol 28: 409-414.
3.
A report of the International Study of Kidney Disease in Children (1978): Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. Kidney Int 13: 159-165.
4.
Al-Saran K, Mirza K, Al-Ghanam G, Abdelkarim M (2006): Experience with levamisole in frequently relapsing, steroid- dependent nephrotic syndrome. Pediatr Nephrol 21: 201-205.
5.
Szeto C, Gillespie KM, Mathieson PW (2000): Levamisole induces interleukin 18 and shifts THI/TH2 balance. Immunology 100: 217-222.
6.
Chen LY, Lin YL, Chiang BL (2007): Levamisole enhances immune response by affecting the activation and maturation of human monocyte-derived dendritic cells. Clin Exp Immunol 151: 174-181.
8.
Jiang L, Dasgupta I, Hurcombe JA, et al. (2015): Levamisole in steroid-sensitive nephrotic syndrome: usefulness in adult patients and laboratory insights into mechanisms of action via direct action on the kidney podocyte. Clin Sci (Lond) 128: 883-893.
9.
Tanphaichitr P, Tanphaichitr D, Sureeratanan J, Chatasingh S (1980): Treatment of nephrotic syndrome with levamisole. J Pediatr 96: 490-493.
10.
British Association for Pediatric Nephrology (1991): Levamisole for corticosteroid dependent nephrotic syndrome in childhood. Lancet 337: 1555-1557.
11.
Dayal U, Dayal AK, Shastry JC, Raghupathy P (1994): Use of levamisole in maintaining remission in steroid sensitive nephrotic syndrome in children. Nephron 66: 408-412.
12.
Rashid HU, Ahmed S, Fatima N, Khanam A (1996): Levamisole in the treatment of steroid dependent or frequent relapsing nephrotic syndrome in children. Bangladesh Ren J 15: 6-8.
13.
Al-Saran K, Grisaru S, Stephens D, Arbus G (2001): Levamisole vs. cyclophosphamide for frequently relapsing steroiddependent nephrotic syndrome. Clin Nephrol 56: 289-294.
14.
Niaudet P, Drachman R, Gagnadoux MF, Broyer M (1994): Treatment of idiopathic nephrotic syndrome with levamisole. Acta Pediatr Scand 73: 637-641.
15.
Bagga A, Sharma A, Srivastava RN (1997): Levamisole therapy in corticosteroid dependent nephrotic syndrome in children. Pediatr Nephrol 11: 415-447.
16.
Donia AF, Amer GM, Ahmed HA, et al. (2002): Levamisole: adjunctive therapy in steroid-dependent minimal change nephrotic children. Pediatr Nephrol 17: 355-358.
17.
Barbano G, Ginevri F, Ghiggeri GM, Gusmano R (1999): Disseminated autoimmune disease during levamisole treatment of nephrotic syndrome. Pediatr Nephrol 13: 602-603.
18.
Bulugahapitiya DT (1997): Liver toxicity in a nephrotic patient treated with levamisole. Arch Dis Child 76: 289.
19.
Palcoux JB, Niaudet P, Goumy P (1994): Side effects of levamisole in children with nephrosis. Pediatr Nephrol 8: 263-264.
20.
Ekambaram S, Mahalingam V, Nageswaran P, et al. (2014): Efficacy of levamisole in children with frequently relapsing and steroid-dependent nephrotic syndrome. Indian Pediatr 51: 371-373.
21.
Donia AF, Ammar HM, El-Agroudy Ael-B, et al. (2005): Long-term results of two unconventional agents in steroid-dependent nephrotic children. Pediatr Nephrol 20: 1420-1425.
22.
Moustafa BH, Tolba OA (2016): Immunosuppressive therapy in children with steroid-resistant, frequently-relapsing, and steroiddependent idiopathic nephrotic syndrome: a single center experience. Electron Physician 8: 2039-2047.
23.
Basu B, Babu BG, Mahapatra TK (2016): Long-term efficacy and safety of common steroid-sparing agents in idiopathic nephrotic children. Clin Exp Nephrol [Epub ahead of print]; doi: 10.1007/s10157-016-1266-8.
24.
Elmas AT, Tabel Y, Elmas ON (2013): Short- and long-term efficacy of levamisole in children with steroid-sensitive nephrotic syndrome. Int Urol Nephrol 45: 1047-1055.
25.
Boyer O, Moulder JK, Grandin L, Somers MJ (2008): Short and long-term efficacy of levamisole as adjunctive therapy in childhood nephrotic syndrome. Pediatr Nephrol 23: 575-580.
26.
Sümegi V, Haszon I, Iványi B, et al. (2004): Long-term effects of levamisole treatmentin childhood nephrotic syndrome. Pediatr Nephrol 19: 1354-1360.
Share
RELATED ARTICLE
| eISSN: | 1644-4124 |
| ISSN: | 1426-3912 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
