부산대학교 도서관

Byline: Viktoria Sumegi (1), Ibolya Haszon (1), Bela Ivanyi (2), Csaba Bereczki (1), Ferenc Papp (1), Sandor Turi (1) Keywords: Nephrotic syndrome; Levamisole; Prednisolone; Relapse rate; Cumulative steroid dose Abstract: The effects of levamisole treatment on long-term outcome were evaluated in a retrospective study of frequently-relapsing (FRNS, n =15), steroid-dependent (SDNS, n =13), and steroid-resistant (SRNS, n =6) nephrotic syndrome in 34 children (21 boys, 13 girls, mean age 5.0+-3.4 years) during a 60-month follow-up period. The definition of frequent relapses was aY=4 relapses per year. The current relapse was treated with prednisolone 60 mg/m.sup.2 per day for 4 weeks, then with 40 mg/m.sup.2 every other day for 4 weeks, after which the dose was tapered by 10 mg weekly. From the beginning of the 5th week, levamisole was introduced at a dose of 2 mg/kg per day. The duration of levamisole treatment was 17+-7 months. Before starting levamisole treatment the mean level of proteinuria was 2.17+-1.34 g/day and the relapse rate was 4.41/year. By the end of levamisole therapy, proteinuria had fallen to 0.142+-0.211 g/day and the relapse rate to 0.41/year. No relapse occurred in 23 of the 34 patients during levamisole treatment. In the 24-month follow-up period after the discontinuation of levamisole, 28 children remained in total remission, while 6 had relapses. The cumulative steroid dose before levamisole therapy was 7,564.4+-3,497.1 mg/year and following the introduction of levamisole 1,472.9+-1,729.9 mg/year ( P < 0.0001). We observed reversible neutropenia in 5 patients, but no other side effects were seen. Our findings suggest that in FRNS and SDNS levamisole significantly reduces both the relapse rate and the cumulative steroid dose therefore, it could be recommended for these patients. In SRNS patients it has also some benefit because proteinuria and the cumulative steroid dose could be reduced significantly. Author Affiliation: (1) Department of Pediatrics, University of Szeged, 14 Koranyi Street, 6721 Szeged, Hungary (2) Department of Pathology, University of Szeged, Hungary Article History: Registration Date: 21/07/2004 Received Date: 10/02/2004 Accepted Date: 22/06/2004 Online Date: 28/10/2004