perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2025-70-5-137-143perinatology-2266Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR THE PRACTITIONERСтероидсберегающая терапия часто рецидивирующего нефротического синдрома препаратом левамизолSteroid-sparing therapy of frequently recurrent nephrotic syndrome with levamizolehttps://orcid.org/0000-0002-3261-1143СафинаА. И.SafinaA. I.

Сафина Асия Ильдусовна — д.м.н., проф., зав. кафедрой педиатрии и неонатологии им. проф. Е.М. Лепского.

420012, Казань, ул. Бутлерова, д.36

420012, Kazan

safina_asia@mail.ruhttps://orcid.org/0000-0002-3632-220XМихайловаТ. В.MihajlovaT. V.

Михайлова Татьяна Владимировна — к.м.н., доцент кафедры педиатрии и неонатологии им. проф. Е.М. Лепского.

420012, Казань, ул. Бутлерова, д.36

420012, Kazan

https://orcid.org/0009-0001-2073-5771СулеймановаИ. М.SulejmanovaI. M.

Сулейманова Ирина Маратовна — врач-педиатр.

420034, Казань, ул. Декабристов, д. 125а

420034, Kazan

https://orcid.org/0009-0007-8844-5432МусинаА. Р.MusinaA. R.

Мусина Аделина Радиковна — врач-нефролог.

420034, Казань, ул. Декабристов, д. 125а

420034, Kazan

Казанская государственная медицинская академия, филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияKazan State Medical Academy, Branch Campus of the Medical Academy of Continuous Professional EducationRussian FederationГАУЗ «Городская детская больница № 1»РоссияCity Children’s Hospital No. 1Russian Federation202514112025705137143Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20252025Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/2266

Терапия пациентов с рецидивирующим стероидчувствительным нефротическим синдромом является важной и до конца не решенной проблемой. Длительное и частое использование высоких доз кортикостероидных препаратов связано с развитием побочных эффектов терапии. Долгосрочной целью лечения стероидчувствительного нефротического синдрома является стойкая ремиссия заболевания, минимизация побочных эффектов и улучшение качества жизни пациента. Международная ассоциация детских нефрологов в 2023 году опубликовала обновленные рекомендации по диагностике и лечению стероидчувствительного нефротического синдрома у детей, согласно которым для выбора наилучшего начального варианта стероидсберегающей терапии и оптимальной последовательности агентов рекомендуется учитывать вариант и тяжесть течения заболевания, возраст, начало полового созревания, потенциальную приверженность к терапии, профиль побочных эффектов, сопутствующие заболевания, стоимость и доступность препаратов. Цель обзора рассмотреть один из вариантов стероидсберегающей терапии стероидчувствительного нефротического синдрома с применением препарата левамизол. Левамизол относится к препаратам обладающим иммуномодулирующим действием, нормализует клеточный иммунитет. Проведенные клинические испытания повысили качество доказательств эффективности и безопасности левамизола при лечении детей с стероидчувствительным нефротическим синдромом. Обзор продемонстрирован клиническим случаем пациента со стероидчувствительным часто рецидивирующим вариантом течения нефротического синдрома, получавшего левамизол. На фоне терапии левамизолом в течение 1,5 лет у ребенка не наблюдалось рецидивов нефротического синдрома и протеинурии по анализам мочи, отсутствовали побочные эффекты. Низкий профиль токсичности, простота мониторинга, низкая стоимость препарата являются преимуществами данного препарата в ряду стероидсберегающих агентов, используемых для терапии стероидчувствительного нефротического синдрома.

Therapy of patients with relapsing steroid-sensitive nephrotic syndrome is an important and unresolved problem. Long-term and frequent use of high doses of corticosteroids is associated with the development of side effects of therapy. The long-term goal of steroid-sensitive nephrotic syndrome treatment is stable remission of the disease, minimization of side effects and improvement of the patient’s quality of life. In 2023, the International Association of Pediatric Nephrologists (IPNA) published updated recommendations for the diagnosis and treatment of steroid-sensitive nephrotic syndrome in children, according to which, in order to choose the best initial option for steroid-sparing therapy and the optimal sequence of agents, it is recommended to take into account the type and severity of the disease, age, onset of puberty, potential adherence, side effect profile, comorbidities, cost and availability of drugs. In our review, we aimed to consider one of the options for steroid-sparing therapy for steroid-sensitive nephrotic syndrome using the drug levamisole. Levamisole is a drug with an immunomodulatory effect, normalizes cellular immunity. The conducted clinical trials have increased the quality of evidence of the efficacy and safety of levamisole in the treatment of children with steroid-sensitive nephrotic syndrome. For the purpose of demonstration, a clinical case of a patient with a steroid-sensitive frequently relapsing variant of nephrotic syndrome treated with levamisole is presented. Against the background of taking levamisole for 1.5 years, the child did not have relapses of nephrotic syndrome, proteinuria according to urine tests. In our case, there were no side effects of levamisole therapy. Low toxicity profile, ease of monitoring, low cost of the drug are the advantages of this drug in a number of steroid-sparing agents used for the treatment of steroid-sensitive nephrotic syndrome.

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The authors declare that there are no conflicts of interest present.