Abstract
BackgroundLevamisole 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.MethodsA 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.ResultsIn 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).ConclusionLevamisole significantly decreases eGFR. However, this decrease is not progressive or irreversible and would not be an indication to discontinue the treatment.
Highlights
Levamisole is an immune-modulating imidazothiol-derived anthelminthic drug which is frequently used as a steroidsparing agent in children with steroid-sensitive nephrotic syndrome
In 8 children, 5 before starting levamisole and 3 after discontinuing, no recent height was available to correlate with the creatinine, and estimated GFR (eGFR) could not be calculated
In 5 patients, the decrease in eGFR below 90 ml/min/1.73 m2 was the reason to stop levamisole treatment. This is the first study reporting on the effect of levamisole on kidney function in children with nephrotic syndrome while on treatment
Summary
Levamisole is an immune-modulating imidazothiol-derived anthelminthic drug which is frequently used as a steroidsparing agent in children with steroid-sensitive nephrotic syndrome. The most frequently described side effects are leucopenia/neutropenia (3.7%), gastro-intestinal upset (2.4%) and skin rash (1.5%) These symptoms are normally reversible upon discontinuing treatment [1]. There are no studies on the effect of levamisole on serum creatinine and estimated GFR (eGFR). We conducted a retrospective cohort study reviewing the serum creatinine values in patients with steroid-sensitive nephrotic syndrome treated with levamisole at our hospital to review the magnitude and reversibility of this observation. 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. 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. This decrease is not progressive or irreversible and would not be an indication to discontinue the treatment
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