الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
This study was carried out on 40 children with steroid dependant minimal change nephrotic syndrome. They were selected from patients who attended nephrology outpatient clinic or admitted to nephrolohy department, Mansoura Urology and Nephrology Center in the period from January 1999. Of them, 31 were males and 9 were females. Their age ranged from 3 to 15 years.
After a thorough history and clinical examination, all patients were subjected to a battery of investigations including urinalysis, 24-hour urinary protein, serum creatinine, liver function tests, total serum cholesterol and complete blood count. Except for 3 patients, HLA class I typing was done for all patients. Renal biopsy was performed for those patients who didn’t do it before so that at start of the study all patients underwent renal biopsy. All specimens were examined by light and immunofluorescent microscopy. Electron microscopic examination was available in 8 patients only.
Patients were prospectively and randomly divided into two equal groups. One group was allocated to receive levamisole and another to receive IV monthly cyclosphamide pulses. Treatment duration was 6 months. Patients were followed up during the 6-month treatment duration and for further 6 months after stopping treatment. Our results revealed the following :
Basal Data :
Sex : Male : female ratio was 3.4:1 Patient history :
a) Allergy : reported in 15% of patients. Of them, 1/3 had bronchial asthma, 1/3 had food allergy, 1/6 had drug allergy and 1/6 had contract dermatitis.
b) Upper respiratory tract infections and relapse of nephrotic syndrome: A definite relation between them was reported in 10% of cases.
Family history:- Among our patients. We reported family history of nephrotic syndrome in 7.5% of allergy in 12.5%, of other renal disease in 10% and consanguinity in 7.5%.
Hypertension: 37.5% of our patients were hypertensive at start of the study.
Microscopic hematuria: Reported in 35% of our cases.
HLA typing: HLA-B16 locus was significantly lower while HLA-B27 locus was significantly higher in our patients that in a control Egyptian group (Healthy kidney donors).
Follow up data:-
Follow up during treatment period (6 months):
- At 3 months: Two patients in each group showed relapse during the first 3
months of treatment. Follow up data of the remaining 36 patients revealed:
a) Clinical follow up: Both groups were comparable regarding overall complications, edema, diastolic blood pressure, hypertension and weight. Urinary tract infections occurred in 28.5% of all patients. One boy levamisole group showed CNS manifestations. Alopecia occurred in two cases of cyclophosphamide group.
b) Laboratory follow up: Both groups were comparable regarding laboratory criteria except for serum bilirubin which was significantly higher in levamisole group and leukocyturia which was significantly higher in cyclophosphamide group.
- At 6 months: At the end of treatment, only 11 patients in levamisole group
and 12 patients in cyclophosphamide group maintained remission. Their follow up data revealed the following: a) Clinical follow up : Both groups were comparable regarding
complications, diastolic blood pressure, hypertension and weight.
Alopecia occurred in 3 patients and high liver enzymes occurred in one
patient of cyclophosphamide group.