Levamisole in Frequently-relapsing and Steroid-dependent Nephrotic Syndrome. 2017

Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. Correspondence to: Dr Sriram Krishnamurthy, Additional Professor, Department of Pediatrics, JIPMER, Pondicherry 605 006, India. drsriramk@yahoo.com.

OBJECTIVE To evaluate the efficacy of levamisole in children with frequently relapsing nephrotic syndrome (FRNS) and steroid dependent nephrotic syndrome (SDNS) when administered on an alternate day ('initial therapy' in all cases) or daily basis ('rescue therapy' in whom alternate day therapy failed). METHODS The records of 95 children (age 1-18y) with FRNS (62) and SDNS (33), who were treated at the Pediatric nephrology clinic, and received levamisole therapy (maximum 2 y duration, between 2010-2013) with a follow-up period of minimum 1 y, were included. RESULTS Alternate day levamisole therapy was efficacious in 73.7% (n=70). The overall efficacy of levamisole therapy was 88.4% (n=84). Levamisole therapy decreased the mean (SD) number of relapses from 4.22 (0.46)/y to 1.35 (0.36)/y (P<0.01); and cumulative median (IQR) prednisolone dosage from 4200 (3200-4300) mg/m2 to 1100 (IQR 500-2900) mg/m2 (P<0.001). On a one-year follow up of the cases in whom levamisole therapy was efficacious during therapy (median 24 mo) (n=84), a frequently relapsing or steroid dependent course continued to persist in 48.8% (41), necessitating oral cyclophosphamide (n= 22) or mycophenolate mofetil (n=19). CONCLUSIONS Daily levamisole therapy was useful in 56% of children who demonstrated failure while on alternate day levamisole therapy, and could be a useful therapeutic option in FRNS and SDNS.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D007223 Infant A child between 1 and 23 months of age. Infants
D007978 Levamisole An antihelminthic drug that has been tried experimentally in rheumatic disorders where it apparently restores the immune response by increasing macrophage chemotaxis and T-lymphocyte function. Paradoxically, this immune enhancement appears to be beneficial in rheumatoid arthritis where dermatitis, leukopenia, and thrombocytopenia, and nausea and vomiting have been reported as side effects. (From Smith and Reynard, Textbook of Pharmacology, 1991, p435-6) L-Tetramisole,Levotetramisole,Decaris,Dekaris,Levamisole Hydrochloride,Solaskil,Hydrochloride, Levamisole
D008297 Male Males
D009404 Nephrotic Syndrome A condition characterized by severe PROTEINURIA, greater than 3.5 g/day in an average adult. The substantial loss of protein in the urine results in complications such as HYPOPROTEINEMIA; generalized EDEMA; HYPERTENSION; and HYPERLIPIDEMIAS. Diseases associated with nephrotic syndrome generally cause chronic kidney dysfunction. Childhood Idiopathic Nephrotic Syndrome,Frequently Relapsing Nephrotic Syndrome,Multi-Drug Resistant Nephrotic Syndrome,Pediatric Idiopathic Nephrotic Syndrome,Steroid-Dependent Nephrotic Syndrome,Steroid-Resistant Nephrotic Syndrome,Steroid-Sensitive Nephrotic Syndrome,Multi Drug Resistant Nephrotic Syndrome,Nephrotic Syndrome, Steroid-Dependent,Nephrotic Syndrome, Steroid-Resistant,Nephrotic Syndrome, Steroid-Sensitive,Nephrotic Syndromes,Steroid Dependent Nephrotic Syndrome,Steroid Resistant Nephrotic Syndrome,Steroid Sensitive Nephrotic Syndrome,Steroid-Dependent Nephrotic Syndromes,Steroid-Resistant Nephrotic Syndromes,Steroid-Sensitive Nephrotic Syndromes,Syndrome, Nephrotic,Syndrome, Steroid-Sensitive Nephrotic
D011507 Proteinuria The presence of proteins in the urine, an indicator of KIDNEY DISEASES. Proteinurias
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005260 Female Females
D005938 Glucocorticoids A group of CORTICOSTEROIDS that affect carbohydrate metabolism (GLUCONEOGENESIS, liver glycogen deposition, elevation of BLOOD SUGAR), inhibit ADRENOCORTICOTROPIC HORMONE secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. Glucocorticoid,Glucocorticoid Effect,Glucorticoid Effects,Effect, Glucocorticoid,Effects, Glucorticoid

Related Publications

Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
January 2006, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
February 2006, Pediatric nephrology (Berlin, Germany),
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
October 2001, Clinical nephrology,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
May 2014, Indian pediatrics,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
September 1988, Acta paediatrica Scandinavica,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
January 2016, Central-European journal of immunology,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
April 2016, Pediatric nephrology (Berlin, Germany),
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
April 2014, Journal of the American Society of Nephrology : JASN,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
December 2023, Clinical journal of the American Society of Nephrology : CJASN,
Evangeline Mary Kiruba Samuel, and Sriram Krishnamurthy, and Singanamalla Bhanudeep, and Sravani Muske
February 2007, Pediatric nephrology (Berlin, Germany),
Copied contents to your clipboard!