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The effect of levamisole on kidney function in children with steroid-sensitive nephrotic syndrome
Pediatric Nephrology ( IF 3 ) Pub Date : 2021-09-06 , DOI: 10.1007/s00467-021-05231-4
Lieke A Hoogenboom 1 , Hazel Webb 1 , Kjell Tullus 1 , Aoife Waters 2
Affiliation  

Background

Levamisole is frequently used as a steroid-sparing agent in children with steroid-sensitive nephrotic syndrome. Side effects, such as neutropenia, gastro-intestinal upset and skin rash, have been reported. We noted an increase in creatinine in some of our patients, but literature on the effect of levamisole on kidney function is lacking.

Methods

A retrospective cohort study was conducted, including patients 1–18 years of age, treated for steroid-sensitive nephrotic syndrome with levamisole at Great Ormond Street Hospital for Children between January 2010 and January 2020. Data was collected on clinical observations and serum creatinine values before, during and after treatment. eGFR was calculated using the Schwartz equation.

Results

In total, 75 children were included in the analysis. The median duration of treatment was 19 (IQR 12–27) months. The median estimated GFR was 134 (IQR 119–160), 101 (IQR 91–113) and 116 (IQR 106–153) ml/min/1.73 m2, respectively, before, during and after treatment with levamisole. The difference between eGFR before and after treatment compared with during treatment was statically significant (P < 0.0001). During the treatment period, the eGFR decrease was not progressive. The median levamisole dose was 2.5 (IQR 2.3–2.6) mg/kg on alternate days, and the dose was not correlated with the decrease in eGFR (r = 0.07, 95% CI − 0.22 to 0.35).

Conclusion

Levamisole significantly decreases eGFR. However, this decrease is not progressive or irreversible and would not be an indication to discontinue the treatment.



中文翻译:

左旋咪唑对激素敏感性肾病综合征患儿肾功能的影响

背景

左旋咪唑经常用作类固醇敏感性肾病综合征儿童的类固醇节约剂。已经报道了副作用,例如中性粒细胞减少、胃肠不适和皮疹。我们注意到一些患者的肌酐升高,但缺乏关于左旋咪唑对肾功能影响的文献。

方法

对 2010 年 1 月至 2020 年 1 月期间在大奥蒙德街儿童医院接受左旋咪唑治疗的 1-18 岁患者进行了一项回顾性队列研究。收集了之前临床观察和血清肌酐值的数据,治疗期间和治疗后。eGFR 使用 Schwartz 方程计算。

结果

总共有 75 名儿童被纳入分析。治疗的中位持续时间为 19 (IQR 12-27) 个月。在左旋咪唑治疗之前、期间和之后,中位估计 GFR 分别为 134 (IQR 119–160)、101 (IQR 91–113) 和 116 (IQR 106–153) ml/min/1.73 m 2 。与治疗期间相比,治疗前后eGFR的差异具有统计学意义(P  < 0.0001)。在治疗期间,eGFR 下降不是进行性的。隔日左旋咪唑的中位剂量为 2.5 (IQR 2.3–2.6) mg/kg,该剂量与 eGFR 的降低无关(r  = 0.07, 95% CI - 0.22 至 0.35)。

结论

左旋咪唑显着降低 eGFR。然而,这种下降不是渐进的或不可逆的,也不是停止治疗的指征。

更新日期:2021-09-07
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