POS-130 EXPERIENCE WITH LEVAMISOLE IN CHILDREN WITH FREQUENTLY RELAPSING AND STEROID DEPENDENT NEPHROTIC SYNDROME HAVING FOLLOW UP AT TIKUR ANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA

Abstract

Nephrotic syndrome is characterized by nephrotic range proteinuria, and hypoalbuminemia,most commonly associated with hyperlipidemia and edema. Without treatment,nephrotic syndrome in children is associated with high risk of death,most commonly from infections. Corticosteroids are the treatment of choice for idiopathic nephrotic syndrome (INS). Although about 80-90% of children with INS respond to corticosteroids, 20-30% become steroid dependent. Chronic corticosteroid therapy in patients with steroid dependent or frequently relapsing NS (FRNS or SDNS) is associated with numerous side effects. Levamisole is an anti helminthic agent with immunomodulatory effect. Levamisole has been considered the least toxic and least expensive steroid sparing drug for preventing relapses of steroid sensitive idiopathic nephrotic syndrome (SSINS). Though FDA doesn’t approve it for this purpose many researches done so far have shown that Levamisole is effective in treatment of children with FR/SDNS. We are using Levamisole in our Hospital but we have no data supporting or negating the use of levamisole as a good choice for treatment of children with SDNS/ FRNS to date. To determine the outcome of pediatric FR/SDNS treated with levamisole among children who had follow up at TASH pedaitric renal clinic. Methods: Retrospective cohort study on clinical records of patients with FR/SDNS having follow up at Tikur Anbessa Specialized Hospital from January 2016 to January 2019 . Charts of 80 patients reviewed and using exclusion criteria 33 patients were excluded from the study. Patient charts were retrieved using patients MRN and type of their disease from registration book at pediatrics renal clinic having follow up at our Hospital during the study period .The collected data was cleaned, Coded and analyzed using SPSS Version 25. Inclusion and Exclusion Criteria: Inclusion criteria: All patients who had FR/SD idiopathic nephrotic syndrome age between 1yr and 18 years attending follow up at TASH pediatric renal clinic. Exclusion criteria: All patients with steroid resistant nephrotic syndrome. All patients of Congenital or Infantile nephrotic syndrome. All patients with CKD. Nephrotic syndrome secondary to systemic illness Among 47 patients with FR/SDNS 32 were males and 15 were females, 21 (44.5%) were FRNS and 26 (55.5%) were SDNS. The duration of Nephrotic Syndrome was 8.75 3.7 yrs, the number of relapses before Levamisole treatment was 3, relapse after Levamisole was 0.7. The duration of Levamisole treatment was 19.9 during levamisole treatment. Levamisole is associated with significant reduction in relapses of FRNS/SDNS.It also significantly reduces adverse effects associated with corticosteroid treatment. The medication is not available in hospital pharmacies and treating those patients who have indications is difficult and the drug should be available at Hospital pharmacies.