Time to remission in first episode of Idiopathic Nephrotic Syndrome in children with response to Levamisole in subsequent relapses

Abstract

Background: Idiopathic nephrotic syndrome (NS) is the most common cause for NS in children. While it responds to steroids in most instances, relapses are also common. In frequently relapsing NS, though agents such as levamisole and cyclophosphamide are commonly used as steroid sparing agents, the response is often unpredictable. In this study, we aimed to determine the association, if any, between time to remission in the first episode of steroid sensitive nephrotic syndrome and the response to levamisole in the subsequent relapses. Materials and methods: The records of the children with steroid sensitive NS were studied. The children were grouped into two categories: group I, where the response to Prednisolone in the first episode occurred in less than 10 days of therapy, and group II, in whom the response to Prednisolone occurred between 10 and 28 days. The response to levamisole in the two groups was compared. Results: The records of 75 children (Males 48) were studied. Group I had 49 (65.3%) children, of whom, 42 children had frequent relapses and were treated with levamisole. 33(78.5%) children showed a good response to levamisole. In group II, all 26 (34.6%) children had frequent relapses and were treated with levamisole. Only 1 child (3.8%) showed a good response. There was a significant association of the time to remission in first episode of NS with the response to levamisole (p<0.001). Conclusion: Children with nephrotic syndrome showing a response to Prednisolone in less than 10 days are more likely to respond to levamisole, especially if the relapse rate is less than 3 in 6 months.