Effect of levamisole in steroid-dependent nephrotic syndrome

Introduction. Childhood idiopathic nephrotic syndrome is characterized by frequent relapsing courses or steroid dependency. Levamisole is a popular drug for treatment of these patients. The purpose of this study was to evaluate levamisole in children with steroid-dependent nephrotic syndrome. Materials and Methods. We retrospectively studied 304 children with a diagnosis of steroid-dependent nephrotic syndrome or frequently relapsing nephrotic syndrome. The mean age at the time of diagnosis was 4.84 years. Following induction of complete remission with steroid therapy based on the International Study of Kidney Disease in Children's protocol and when they were taking alternative days of steroid, 2.5 mg/kg of levamisole was administered. Results. The steroid dose was significantly decreased (mean reduction of 0.39 ± 0.46 g to 0.33 ± 0.38 g) after treatment with levamisole (P <.001). The number of relapses also significantly decreased (mean reduction of 0.92 ± 0.98 episodes to 1.07 ± 1.20 relapses per year; P <.001). The 14.5-month administration of levamizole had a sensitivity of 67.5 and a specificity of 71.9 to reach a dose reduction of more than 50 in steroid therapy. The duration of levamizole treatment was associated with more than 50 reduction in the number of relapses (P <.001). A 14.5-month treatment with levamizole had a sensitivity of 62.3 and a specificity of 63.6 to reach a relapse reduction of more than 50. Conclusions. Levamisole appears to be effective in prolonging the duration of remission and decreasing the steroid dose in children with steroid-dependent nephrotic syndrome