Levamisole in Children with Idiopathic Nephrotic Syndrome: Clinical Efficacy and Pathophysiological Aspects
Department of Pediatrics, University Hamburg-Eppendorf, 20246 Hamburg, Germany
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kangwon 26426, Korea
Department of Pediatrics, Asklepios Klink Nord-Heidberg, 22417 Hamburg, Germany
Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck 6020, Austria
Department of Pediatric Nephrology, Chungnam National University Hospital, Daejeon 35015, Korea
Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(6), 860; https://doi.org/10.3390/jcm8060860
Received: 30 May 2019 / Revised: 11 June 2019 / Accepted: 12 June 2019 / Published: 16 June 2019
(This article belongs to the Special Issue Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD))
Steroid sensitive nephrotic syndrome is one of the most common pediatric glomerular diseases. Unfortunately, it follows a relapsing and remitting course in the majority of cases, with 50% of all cases relapsing once or even more often. Most children with idiopathic nephrotic syndrome respond initially to steroid therapy, nevertheless repeated courses for patients with relapses induce significant steroid toxicity. Patients with frequent relapses or steroid dependency thus require alternative treatment, such as cyclophosphamide, cyclosporine, tacrolimus, mycophenolate mofetil, levamisole, or rituximab. To reduce the relapse rate, several drugs have been used. Among these, levamisole has been considered the least toxic and least expensive therapy. Several randomized controlled trials (RCT) showed that levamisole is effective in reducing the relapse risk in steroid sensitive forms of nephrotic syndrome with a low frequency of side effects. Levamisole is a synthetic imidazothiazole derivative with immune-modulatory properties. In this article, we review recent data from randomized trials and observational studies to assess the efficacy of levamisole in frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome.