LEVAMISOLE TREATMENT IN STEROID-SENSITIVE AND STEROID-RESISTANT NEPHROTIC SYNDROME

Since 1992 we have treated 11 children with frequently relapsing stero id-sensitive (n=6) or steroid-resistant (n=5) nephrotic syndrome with levamisole. All had been non-responsive to other immunosuppressive med ication before levamisole treatment. All steroid-sensitive patients ha d signs of steroid toxicity. At least 1 kidney biopsy had been perform ed prior to study in each patient. Five children had minimal glomerula r changes and the other 6 focal segmental glomerular sclerosis. The pa tients were treated with levamisole (2.5 mg/kg per 48 h) for at least 2 months (up to 18 months, median 10 months). Two patients had additio nal immunosuppression (cyclosporine A) during levamisole treatment. Al l patients with steroid-sensitive nephrotic syndrome became free of pr oteinuria within 2 months and have remained in remission after discont inuation of levamisole (follow-up time 8-50 months, median 24 months). None of the children with steroid-resistant nephrotic syndrome experi enced a remission. Side effects were observed in 2 patients and includ ed a granulocytopenia and a severe psoriasis-like cutaneous reaction; both were reversible after discontinuation of levamisole. We conclude that levamisole is of benefit in steroid-sensitive nephrotic syndrome but not in steroid-resistant nephrotic syndrome.