Levamisole for children with nephrotic syndrome: new evidence for the use of an “old” drug

Vivarelli, Marina; Emma, Francesco

doi:10.1016/j.kint.2018.10.008

Cited by 16 publications

(6 citation statements)

References 9 publications

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“…Our non-IgAN group consists mainly of membranous nephropathy, minimally pathological nephropathy, mesangial proliferative glomerulonephritis and other diseases characterized by nephrotic syndrome. Patients with nephrotic syndrome are often in a state of hypercoagulability, hyperfibrinolysis, hyperlipemia, and hypoproteinemia [31] . This may explain why the relevant index levels for blood clotting and blood lipids were higher in the non-IgAN group than in the IgAN group, such as FIB, D2, and TC, while the TP levels were lower in the non-IgAN group than in the IgAN group.…”

Section: Discussionmentioning

confidence: 99%

A non-invasive diagnostic model of immunoglobulin A nephropathy and serological markers for evaluating disease severity

Han¹,

Wang²,

Zhu³

et al. 2019

Chinese Medical Journal

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Background:Immunoglobulin A nephropathy (IgAN) is the most common pathological type of glomerular disease. Kidney biopsy, the gold standard for IgAN diagnosis, has not been routinely applied in hospitals worldwide due to its invasion nature. Thus, we aim to establish a non-invasive diagnostic model and determine markers to evaluate disease severity by analyzing the serological parameters and pathological stages of patients with IgAN.Methods:A total of 272 biopsy-diagnosed IgAN inpatients and 518 non-IgA nephropathy inpatients from the Department of Nephrology of Chinese People's Liberation Army General Hospital were recruited for this study. Routine blood examination, blood coagulation testing, immunoglobulin-complement testing, and clinical biochemistry testing were conducted and pathological stages were analyzed according to Lee grading system. The serological parameters and pathological stages were analyzed. The receiver operating characteristic (ROC) analysis was performed to estimate the diagnostic value of the clinical factors. Logistic regression was used to establish the diagnostic model.Results:There were 15 significantly different serological parameters between the IgAN and non-IgAN groups (all P < 0.05). The ROC analysis was performed to measure the diagnostic value for IgAN of these parameters and the results showed that the area under the ROC curve (AUC) of total protein (TP), total cholesterol (TC), fibrinogen (FIB), D-dimer (D2), immunoglobulin A (IgA), and immunoglobulin G (IgG) were more than 0.70. The AUC of the “TC + FIB + D2 + IgA + age” combination was 0.86, with a sensitivity of 85.98% and a specificity of 73.85%. Pathological grades of I, II, III, IV, and V accounted for 2.21%, 17.65%, 62.50%, 11.76%, and 5.88%, respectively, with grade III being the most prevalent. The levels of urea nitrogen (UN) (13.57 ± 5.95 vs. 6.06 ± 3.63, 5.92 ± 2.97, 5.41 ± 1.73, and 8.41 ± 3.72 mmol/L, respectively) and creatinine (Cr) (292.19 ± 162.21 vs. 80.42 ± 24.75, 103.79 ± 72.72, 96.41 ± 33.79, and 163.04 ± 47.51 μmol/L, respectively) were significantly higher in grade V than in the other grades, and the levels of TP (64.45 ± 7.56, 67.16 ± 6.94, 63.22 ± 8.56, and 61.41 ± 10.86 vs. 37.47 ± 5.6 mg/d, respectively), direct bilirubin (DB) (2.34 ± 1.23, 2.58 ± 1.40, 1.91 ± 0.97, and 1.81 ± 1.44 vs. 0.74 ± 0.57 μmol/L, respectively), and IgA (310.35 ± 103.78, 318.48 ± 107.54, 292.58 ± 81.85, and 323.29 ± 181.67 vs. 227.17 ± 68.12 g/L, respectively) were significantly increased in grades II–V compared with grade I (all P < 0.05).Conclusions:The established diagnostic model that combined multiple factors (TC, FIB, D2, IgA, and age) might be used for IgAN non-invasive diagnosis. TP, DB, IgA, Cr, and UN have the potential to be used to evaluate IgAN disease severity.

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Section: Discussionmentioning

confidence: 99%

A non-invasive diagnostic model of immunoglobulin A nephropathy and serological markers for evaluating disease severity

Han¹,

Wang²,

Zhu³

et al. 2019

Chinese Medical Journal

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“…[20][21][22][23][24] Considering the results of Sinha A et al in above RCT, Vivarelli M et al also suggested use levamisole in FR/ SD. 25 Levamisole is also under investigation as adjuvant agent after induction of remission with daily dose in children during first episode of nephrotic syndrome to prevent future relapses and morbidity associated with long term steroid therapy. 14 Strength and limitations of this study: It is a retrospective data, lack of equal number of FR and SD, use of different dosage schedule (daily in 33 and alternate day in 48 cases), lack of strict definition of effectiveness which may have led to exclusion of SD cases who were switched to cyclophosphamide/CNI before completion of 6 months of minimum duration, lack of strict monitoring for side effects like anti-nuclear cytoplasmic antibodies (ANCA) and variation of steroid dosage for treatment of relapse which was high during initial years and lower in the later years of practice as reported previously.…”

Section: Methodsmentioning

confidence: 99%

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

Moorani¹,

Zubair²,

Veerwani

et al. 2020

Pak J Med Sci

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Objectives: To determine the effectiveness of levamisole in maintaining remission of proteinuria in children with frequent relapsing and steroid dependent nephrotic syndrome (FR/SDNS). Methods: This observational study on 81 children with FR /SDNS was carried out from June 2007 - June 2017 at The Kidney Center-Postgraduate Training Institute, Karachi-Pakistan. Levamisole (leva) along with low dose prednisolone on alternate day (AD) was used after induction of remission with daily oral prednisolone in children with FR/ SDNS for 6-36 months. Patients with steroid resistance were excluded. Data was analyzed using descriptive statistics. Results: Eighty-one patients with FR (66) or SD (15) received levamisole treatment. Mean age at diagnosis was 3.72 ±2.33 years. Levamisole was used on AD in 59.25% and daily in 40.74% of cases. Twenty-four could not complete six months and were excluded, 57 patients completed treatment duration of 15.68±9.93 months and 51 post-leva follow-up of 11.70±11.23 months. Mean cumulative prednisolone dose per patient before, on-leva and post-leva was 3389.81±2785.22, 2471.97±2024.98 and 661.37± 905.37 mg respectively. Mean relapse rate per year before leva, on -leva and post -leva was 3.30 ±0.50,0.98± 1.1and 0.79±1.27 respectively. Levamisole was effective in 90% of patients. During post-leva follow up, 76.4% patients, maintained remission, whereas 23.5% behaved as FR/SD and require further immunosuppressive therapy. Conclusions: Levamisole was effective in maintaining remission in 90% while on treatment, whereas it maintained remission after discontinuation in 76.4% cases. Levamisole may be used as first steroid sparing agent before other immunosuppressive therapies in children with FR/SDNS. Further studies are required for optimal duration and dosage schedule. doi: https://doi.org/10.12669/pjms.36.6.2337 How to cite this:Moorani KN, Zubair AM, Veerwani NR, Hotchandani HJ. Efficacy of Levamisole in Children with Frequent Relapsing and Steroid Dependent Nephrotic Syndrome at Tertiary Care Center-Karachi. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2337 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…While few retrospective studies report its efficacy when administered daily (Supp. Table VII), the safety of this strategy should be examined in controlled studies with close monitoring for adverse effects, including neutropenia, raised transaminases, antineutrophil cytoplasmic antibodies and/or small vessel vasculitis [63,66,67].…”

Section: Non-corticosteroid Therapiesmentioning

confidence: 99%

Steroid Sensitive Nephrotic Syndrome: Revised Guidelines

Sinha

Bagga²,

Banerjee

et al. 2021

Indian Pediatr

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Justification Steroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management. Objective To frame revised guidelines on diagnosis, evaluation, management and supportive care of patients with the illness. Process The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings. Recommendations The initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.

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Levamisole for children with nephrotic syndrome: new evidence for the use of an “old” drug

Cited by 16 publications

References 9 publications

A non-invasive diagnostic model of immunoglobulin A nephropathy and serological markers for evaluating disease severity

A non-invasive diagnostic model of immunoglobulin A nephropathy and serological markers for evaluating disease severity

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

Steroid Sensitive Nephrotic Syndrome: Revised Guidelines

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