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      Levamisole in Steroid-Sensitive Nephrotic Syndrome Children with Frequent Relapses and/or Steroid Dependency: Comparison of Daily and Every-Other-Day Usage

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          Steroid dependency (SD) and frequent relapses (FR) are common with steroid-sensitive nephrotic syndrome (SSNS). We assessed the effectiveness of daily levamisole in 36 children with SSNS with FR and/or SD. Twenty patients (group 1) were given levamisole 2–3 mg/kg q.o.d. for 4–24 months. Sixteen (group 2) had relapses within 3 months: 5 received levamisole q.d. for 3–18 months, and 11 q.d. for 6 months and then q.o.d. for 4–18 months. Follow-up was 4–36 (mean 20.4 ± 9.2) months. After therapy, relapses (4.82 ± 3.15 vs. 2.01 ± 2.5 in group 1; 5.97 ± 3.38 vs. 1.34 ± 2.1 in group 2; p < 0.05) and prednisolone doses (0.57 ± 0.37 vs. 0.15 ± 0.33 mg/kg/day in group 1; 0.61 ± 0.42 vs. 0.19 ± 0.35 mg/kg/day in group 2; p < 0.05) decreased. Relapse frequency, prednisolone dose, response percentage, and survival curves for remission did not differ between groups. Group 1 had five episodes of leukopenia, and group 2 had four. White blood cell counts normalized after levamisole was discontinued. Serum blood urea nitrogen/creatinine and alanine aminotransferase/aspartate aminotransferase levels were normal. Levamisole is effective in maintaining remission in children with SSNS and FR and/or SD. Daily levamisole can be considered when responses to q.o.d. usage are unsatisfactory.

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          Inhibition of nitric oxide synthesis in septic shock: how much is beneficial?

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            Levamisole therapy in corticosteroid-dependent nephrotic syndrome.

            The effect of prolonged treatment with levamisole was examined in 43 patients (30 boys) with steroid-dependent nephrotic syndrome (SDNS). The mean age at institution of treatment was 4.0 +/- 2.0 years. Fourteen patients had previously received cyclophosphamide with an ensuing remission of 8.5 +/- 10 months. Following induction of remission with prednisolone, levamisole was administered at a dose of 2.5 mg/kg body weight on alternate days. Prednisolone was tapered by 2.5-5 mg every 4 weeks to 0.5 mg/kg on alternate days. The duration of levamisole therapy ranged from 6 to 31 months (mean 17.4 +/- 8.4 months); 15 patients received levamisole for more than 18 months and 10 for more than 24 months. Prednisolone was discontinued in 18 patients after a mean duration of 11.7 +/- 7.1 months, whereas in 21 patients its dose was reduced to 0.2-0.4 mg/kg on alternate days. The mean relapse rate prior to levamisole therapy was 3.0 +/- 1.5 relapses/year, which reduced to 0.9 +/- 0.7 relapses/year during levamisole treatment (P < 0.001). A comparison of the response in 14 patients who had previously received cyclophosphamide with the other 29 patients did not show any significant difference. There were no side effects of levamisole therapy. Our findings suggest that prolonged treatment with levamisole is beneficial and safe in SDNS, with a marked steroid-sparing effect. A significant proportion of these patients can be kept in remission on levamisole alone.
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              Immunosuppressive agents in childhood nephrotic syndrome: a meta-analysis of randomized controlled trials.

              Many children with steroid-sensitive nephrotic syndrome (SSNS) relapse frequently and receive immunosuppressive agents. In this systematic review of randomized controlled trials (RCTs), the benefits and harms of these immunosuppressive agents are evaluated.

                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                August 2004
                17 November 2004
                : 97
                : 4
                : c137-c141
                Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan/ROC
                79172 Nephron Clin Pract 2004;97:c137–c141
                © 2004 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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                Figures: 1, Tables: 1, References: 17, Pages: 1
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