Efficacy of Levamisole in children with Frequent Relapsing and Steroid Dependent Nephrotic Syndrome at Tertiary Care Center-Karachi

Moorani, Khemchand N; Zubair, Aasia Mohammad; Veerwani, Nanga Ram; Hotchandani, Harnam Jaichand

doi:10.12669/pjms.36.6.2337

Cited by 7 publications

(11 citation statements)

References 21 publications

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“…Most other recent studies used doses of 2-3 mg/kg on alternate days for 6-24 months. Some observational studies have used doses of 2-2.5 mg/kg daily for 4-24 months [143][144][145][146][147][148][149] with three studies [147][148][149] suggesting reductions in relapse rates in patients who had not responded to alternate-day LEV. These data require further larger RCTs, powered to detect a difference, if any, for confirmation.…”

Section: Levamisolementioning

confidence: 99%

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Trautmann

Boyer²,

Hodson³

et al. 2022

Pediatr Nephrol

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Idiopathic nephrotic syndrome is the most frequent pediatric glomerular disease, affecting from 1.15 to 16.9 per 100,000 children per year globally. It is characterized by massive proteinuria, hypoalbuminemia, and/or concomitant edema. Approximately 85–90% of patients attain complete remission of proteinuria within 4–6 weeks of treatment with glucocorticoids, and therefore, have steroid-sensitive nephrotic syndrome (SSNS). Among those patients who are steroid sensitive, 70–80% will have at least one relapse during follow-up, and up to 50% of these patients will experience frequent relapses or become dependent on glucocorticoids to maintain remission. The dose and duration of steroid treatment to prolong time between relapses remains a subject of much debate, and patients continue to experience a high prevalence of steroid-related morbidity. Various steroid-sparing immunosuppressive drugs have been used in clinical practice; however, there is marked practice variation in the selection of these drugs and timing of their introduction during the course of the disease. Therefore, international evidence-based clinical practice recommendations (CPRs) are needed to guide clinical practice and reduce practice variation. The International Pediatric Nephrology Association (IPNA) convened a team of experts including pediatric nephrologists, an adult nephrologist, and a patient representative to develop comprehensive CPRs on the diagnosis and management of SSNS in children. After performing a systematic literature review on 12 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, recommendations were formulated and formally graded at several virtual consensus meetings. New definitions for treatment outcomes to help guide change of therapy and recommendations for important research questions are given.

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Section: Levamisolementioning

confidence: 99%

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Trautmann

Boyer²,

Hodson³

et al. 2022

Pediatr Nephrol

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“…Moorani et al, found fever (86.7%), cough (46.7%), urinary symptoms (20%), vomiting (13.3%), diarrhea (11.7%), abdominal pain(6.7%) and dehydration (3.3%). 6 Mahvish et al, found fever (64.9%), chills/rigor (18.9%), abdominal pain (32.4%), diarrhea and/or vomiting (13.5%), urinary symptoms (dysuria, increased frequency) (24.3%), respiratory symptoms (cough and/or breathing difficulty) (32.4%), shock (8.1%) and hypotension (10.8%). 13 In our study severe ascites was found in 34 (77.3%) cases and not severe ascites was in 10 (22.7) cases.…”

Section: Discussionmentioning

confidence: 98%

“…Relapses in steroid sensitive Nephrotic Syndrome often follow infections of upper airway or gastrointestinal tract. 6 An abnormality in the functions of the T lymphocytes and in particular the suppressor T…”

Section: Introductionmentioning

confidence: 99%

Clinical Spectrum of Major Infection in Hospitalized Children with Nephrotic Syndrome at a Tertiary Care Hospital

Ahmed,

Ali,

Dey

et al. 2023

Northern Int. Med. Coll. J.

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Background : Children with Nephrotic Syndrome (NS) are exposed to multiple infections resulting in significant morbidity and mortality. Besides being a common cause of mortality, infections may also be responsible for a poor response to steroid therapy or induce relapse in a child with Nephrotic Syndrome. Aims: To assess the clinical spectrum of major infection in hospitalized children with Nephrotic Syndrome. Materials and Methods: This hospital based cross-sectional study was done in the Department of Paediatrics, Sylhet M A G Osmani Medical College Hospital, Sylhet, Bangladesh. In this study, sample size was 44 diagnosed cases of Nephrotic Syndrome with infection. After taking consent, detailed history and thorough physical examination were done in each patient. All data were collected in a preformed questioner and finally collected data were expressed in tabulated form. Results: In our study total 44 children with Nephrotic Syndrome were enrolled with the mean age of 5.98 ± 2.93 years and most of the childhood Nephrotic Syndrome was aged between 2 to 8 years (75.0%); 23 (52.3%) patients were male, and 21 (47.7%) patients were female with a ratio of male to female of 1.1:1. The common clinical symptoms of major infection were fever (79.5%) and cough (70.5%). Other clinical presentations were throat pain (18.2%), abdominal pain (15.9%), runny nose (11.4%), burning micturition (9.1%), respiratory distress (6.8%), vomiting (4.5%) and leg pain (4.5%). Relapse of Nephrotic Syndrome was found in 33 (75.0%) cases. The most common major infection was pneumonia (50.0%), followed by urinary tract infection (20.5%), Upper respiratory tract infection (15.9%), pneumonia with UTI (6.8%), cellulitis (4.5%) and pneumonia with UTI with spontaneous bacterial peritonitis (2.3%). The most common isolated organisms in urine were Escherichia coli (27.3%), followed by Klebsiella pneumoniae (2.3%). Conclusion: The common symptoms of major infection in Nephrotic Syndrome are fever and cough. The most common major infection was pneumonia and urinary tract infection. Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 544-547

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“…Univariate logistic regression was used to obtain the odds of severe disease. Factors used in logistic regression were age (children <5 years particularly), low serum albumin (found to be a predictive factor in a previous study), gender, the commonest serotype observed, presence of more than two immunosuppressive agents (presumed higher risk) and initial episode (versus relapses; in view of significant proportion of children with onset of NS and PnI) [7,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of pneumococcal infections being a trigger for the onset of NS may be more than speculation, akin to novel coronavirus (SARS CoV2) reportedly triggering various glomerular diseases [18,19,22,25,26]. Respiratory tract infections were observed to be the commonest infections in children at the onset of NS and a few reports mention identification of S. pneumoniae as the culprit organism [13,27,28]. Infections are also known to be a significant risk factor for acute kidney injury in children with NS; however, it was not commonly observed and was not explored in this study [29].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and outcomes of pneumococcal sepsis in children with nephrotic syndrome in a developing country

et al. 2022

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Background Pneumococcal infections are common in children with nephrotic syndrome. Knowledge of the commonly available serotypes and antibiotic susceptibility will help in prevention and appropriate management of pneumococcal sepsis, especially in resource-limited countries. Methods Demographic, clinical, and laboratory data on children with nephrotic syndrome and pneumococcal infections were extracted from the electronic medical records. Results Sixty-three isolates of pneumococci obtained from 60 children with nephrotic syndrome, over a period of 14 years, were included in the study. This represented 18% of all pneumococcal infections occurring in children during the same period. Commonly available vaccines covered up to 58% of all the serotypes causing infection. Severe disease, with shock, intensive care admission and/or meningitis, was observed in 38% children and mortality was observed in 10%. Resistance to commonly used antibiotics was not observed, except for erythromycin. Conclusions Pneumococcal sepsis was observed to be common in children with nephrotic syndrome and results in significant morbidity and mortality. Commonly used antibiotics were observed to be effective in management of the infections.

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Efficacy of Levamisole in children with Frequent Relapsing and Steroid Dependent Nephrotic Syndrome at Tertiary Care Center-Karachi

Cited by 7 publications

References 21 publications

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Clinical Spectrum of Major Infection in Hospitalized Children with Nephrotic Syndrome at a Tertiary Care Hospital

Epidemiology and outcomes of pneumococcal sepsis in children with nephrotic syndrome in a developing country

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