Levamisole effect in children with frequently relapsing or steroid-dependent idiopathic nephrotic syndrome

Background: Idiopathic nephrotic syndrome of childhood often is could lead to  frequent relapses or steroid dependency. Levamisole has been used for this purpose in recent years. But its short and long-term efficacy is still under investigation. This study was done to evaluate the effects of levamisole in idiopathic nephrotic syndrome among children.

Methods: 20 children (11 boys, 9 girls, mean age 6.3+3.3 years) with steroid dependency or frequent relapses were included in the study. After induction of remission with prednisolone 60 mg/m2/day, levamisole was added in a dose of 2.5mg/kg on alternate days while prednisolone dose was reduced to 40 mg/m2/every other day. Then prednisolone was gradually tapered and discontinued. Then the relapse rate and the total cumulative dose of prednisolone before and during levamisole therapy were compared.

 Results: The duration of levamisole therapy was 25±18.5 months. The relapse rate was 2.43±0.98/y before and 0.73±0.78/y during levamisole therapy .The difference was statistically significant (P<0.0001). The cumulative steroid dose was 513±192 mg/m2/months before levamisole which was reduced to 292±101 mg/m2/months following levamisole introduction (P<0.0001). Levamisole was effective in15 (75%) patients. No side effect was reported during levamisole therapy.

Conclusion: levamisole is efficacious in managing steroid-dependent frequent-relapsing idiopathic nephrotic syndrome of childhood and long-term relapse-free periods may be expected.