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Background: Steroid sensitive nephrotic syndrome patients usually develop relapses in 40-50% of cases and exert significant burden on healthcare system and different treatment modalities are being used for sustained remission of relapses. Objective: To compare the efficacy of levamisole versus mycophenolate mofetilin children with frequently relapsing steroid sensitive nephrotic syndrome. Study type, settings & duration: This study was conducted at Department of Pediatric Nephrology, The Children's Hospital and Institute of the Child Health, Multan from July 2020 to June 2021. Methodology:; Children (n = 80) with Steroid-sensitive Nephrotic syndrome frequent Relapsers were randomized in 2 groups; Group A received Levamisole 2-2.5 mg/kg on alternate days for 6 months while group B received MMF (750-1000 mg/m2 daily) along with standard therapy i. e prednisolone at a dose of 60 mg/m2 per day for 4-8 weeks or less if reached absence of proteinuria for 3 consecutive days, followed by 40 mg/m2 on alternate days for 2 weeks followed by gradual tapering over 1-2 months to the minimum dose of 0.5 to 1 mg/kg/day for a total duration of 6 months. Results: Our study included 80 children presenting with frequently relapsing steroid sensitive nephrotic syndrome. Of these 80 study cases, 63.8% (n=51) were boys while 36.2% (n=29) were girls. Mean age of our study cases was 7.45±2.08 years (ranging from 3 to 12 years (boys 6.78±1.50 years versus girls 8.62±2.44 years, p=0.001) and 61.3% (n=49) were aged more than 6 years. Mean weight of our study cases was 24.98±8.12 kilograms (minimum weight 17 Kg to maximum 37 Kg). Mean duration of nephrotic syndrome was noted to be 2.11±1.02 years (1 year to 3 years) and most of these children i.e. 43 (53.7%) belonged to urban areas and 37 (46.3%) were from poor family background. Overall efficacy was noted to be 70.0% (n=56). Efficacy in group A was 90% (n=36) while that in group B it was 50.0% (n=20) (p=0.001). Conclusion: Our study results support the use of Levamisole in children with frequently relapsing steroid sensitive nephrotic syndrome as it was significantly more efficacious in remission of relapses in these children as compared with mycophenolatemofetil. Levamisole was found to be quite safe, reliable and without any side effects which should be given to these children for desired outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the role of montelukast in preventing relapses in childhood idiopathic steroid sensitive nephrotic syndrome (SSNS). METHODS: This quasi-experimental, open label study was conducted at Department of Paediatric Nephrology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan. Total of 106 patients with firstepisode of nephrotic syndrome aged 1-10 years were enrolled from February-May 2019 and non-randomly assigned to Group-A & Group-B (53 patients in each group). All patients in both groups were started on prednisolone 2mg/kg single morning dose for 4-weeks as per institutional protocol. Group-A (Cases) also received montelukast 5 mg daily at bedtime for at least 12 months while Group-B (control) was not given montelukast. All patients were followed up for one year till May 2020 to monitor the response to treatment and evidence of relapse. Ten patients were excluded from final analysis due to loss to follow-up (n=3; 2 in Group-A and 1 in Group-B) or showing steroid resistance (n=7; 3 in Group-A and 4 in Group-B). RESULTS: Out of 96 children (48 each in Group-A & B), 58 (60.4%) were males. Mean age was 4.7±1.9 years and most of children (n=64; 66.7%), were aged between 2-6 years. Overall relapse rate of 35.4% (n=34/98) was observed, with 9/48 (18.8%) patients in Group-A compared to 25/48 (52.1%) patients in Group-B (p<0.001). Out of 34 patients with relapse, 20 (58.8%) were males and 14 (41.2%) were females. CONCLUSION: Montelukast showed significant efficacy in preventing relapse rate in children with SSNS during one year of follow-up. [ABSTRACT FROM AUTHOR]