FREQUENTLY RELAPSING STEROID-SENSITIVE ID IOPATHIC NEPHROTIC SYNDROMEIN CHILDREN - ITS TREATMENT WITH LEVAMISOLE

Background and objective: The treatment of frequently relapsing steroi d-sensitive nephrotic syndrome in children with established immunosupp ressive drugs (steroids, cyclophosphamide, cyclosporin A) sometimes pr esents problems because of the expected incidence of side effects. Sti mulation of the immune system with the anthelminthic drug levamisole i n this disease has been documented. Aim of this study was to assess in a prospetive but uncontrolled series of observations its value and si de effects. Patients and methods: 25 patients (15 boys, ten girls; med ian age 10 [3.5-22] years) were given levamisole, 2 mg/kg/48 h. Before this treatment was started eight of the children/adolescents (32%) ha d frequent relapses and 17 (68%) had become steroid-dependent. treatme nt was started during steroid-induced remission and continued for 3-24 (median 6) month, while steroids were discontinued after four weeks. Results: Relapse frequency per patient month was reduced from a mean o f 0.5 (0.33 -0.83) before to 0.31 (0 - 0.67) during levamisole adminis tration (P < 0.001). In 12 patients (48%) no or considerably fewer rel apses were observed. Patients with exclusively frequent relapses respo nded to levamisole better than those with steroid dependence (7/8 [87. 5%] vs. 5/18 [27.7%], P = 0.01). Side effects were reversible leukopen ia in two patients and nonspecific skin rash as well as epigastric pai n in one patient. Conclusion: Levamisole is an efficacious addition or alternative, with a low incidence of side effects, in the treatment o f frequently relapsing nephrotic syndrome, particularly so in yet ster oid-dependent patients.