My son Kaif had Minimal Change NS since Feb2009. First Med started with 45Mg Pred two month and slowly tapered in next two month. He was absoluately well for one month without pred. One day he caught cold and cough and started increasing proturea +1,+2 and +3 within a week time.Nephrologist advice me to start pred again same like first episode. Since last week he was taking 5mg prednisolone alternate day. First three days his proteinuria traced and slowly increasing to +1. All of sudden on October 12th he had cough and throat pain and proturia was nil but on 14th he jumped to 4+ then continued to 3+ till today.
Date Pred Protn Health
October 12, 2009 5 Nil Cold and Cough
October 13, 2009 1+ Cold and Cough
October 14, 2009 20 4+ Cold and Cough
October 15, 2009 20 3+ Cold and Cough
October 16, 2009 30 3+ Well
October 17, 2009 30 4+ Well
October 18, 2009 40 3+ Well
Looking on above details i feel he once again relapsed(2nd time). I consultated to local Nephrologists , he advising me to start medicine like LEVAMISOLE 50 MG. Should i restart Prednisolone or move to LEVAMISOLE as per Nephrologist advice. Pls pls advice me.
I do appriciate all sujestion and advice.
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Second relapse
- By Kaif
- Posted October 18, 2009 at 2:04 pm · 6 replies
- In Children with nephrotic syndrome
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- By sjaved
- Posted October 22, 2009 at 5:56 am
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As far as i know, your son will need prednisolone to take him in to remission and then levamisole can be started to keep him in remission.
My son was first diagnosed with Nephrotic in March 2008 and his first remission last 6 months but since then he has relapsed four times with latest being two weeks ago. He is responding to the Prednisolone for going in to remission and we have a consultant appointment coming next week to discuss levamisole treatment.
Over here in UK they usually wait for the child to have about 4 relapses in a year before considering alternative medicine unless there are no other compelling reasons to change medication early.
- By MaryToronto
- Posted October 23, 2009 at 1:47 am
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Sjaved:
What caused your sons relapse the first time after six months? My son (5 MCNS) is two weeks free pred and is doing fine but I am worried when it will come back. (This is his first time off pred). The way he looks and feels now, it seems like there is nothing wrong with him or will there ever be, but it is just a waiting game.
So much worry with the H1N1 now and flu/cold season, it is a stressful time.
Kaif:
If this was his only time on pred, why would they want to intorduce Levamisole so quickly? Is this common or wouldn't the neph try pred again before jumping into Levamisole?
Thanks.
Mary
- By ChrisandMom
- Posted October 23, 2009 at 4:27 am
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The only time you should give the pred (in my opinion and knowledge) is when the doctor tells you its time to. The immune suppression as well as the long term side effects need to be considered. I wouldnt recommend restarting the prednisone without the docs orders.
Please know that I am not against prednisone at all. Chris has been through 5 or more rounds of it over the past 4 years at least. and he starts the rounds at 80mg. He just relapsed again on monday (symptoms started a week before) so he's on the 80mg/day now. They get him in remission, for about 4 months or so this last time. But it has weakened his bones over time. It started in Aug 05.
Its such an individualized condition at times. For all of us, I hope the remissions come quickly and sustain a long time.
Cheri
- By Kaif
- Posted October 23, 2009 at 5:08 am
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Thnx! S.Javed and Cheri for reply
Relapse is happening whenever he have cough/cold and tounsilitiese throat pain. Now i consulted with another Ped. Nephrologist and he sujjested me that if he have an early relapse then we will consider Levamisole not now. His protueria is nill when we had given him 40 mg prednisolone continue 3 days. Nephrologist advised me to 30Mg two weeks,20 mg 4 weeks, 10 mg 8 weeks and 5 mg 8 weeks. Early relapse then we will consider Levamisole. when ever he is on 20 mg prednisolone then every thing seems to be ok but when we are down to 10 mg or 5 mg then all of suden he will get cold/cough then relapse will happen. I realy appriciated your advice.
- By sjaved
- Posted October 23, 2009 at 9:48 am
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Kaif,
My son was diagnosed first time around in March 2008 then first relapse was in Nov 08, second in Feb 09, third on Jun 09 and the most recent one in Oct 09. For each relapse he had to go through a course of Prednisolone and at the time of the last two relapses he was having a trickle dose (5mg alternate days) of Prednisolone but still managed to relapse.
For each relapse there was some common ailment like cough or cold which we suspect triggered it though the last one we are not sure what could have triggered it. The good thing about his case is that he has, so far, responded well to prednisolone and goes in remission with in a week of starting the course of prednisolone (usually 45mg to start with) but to keep him in remission the doctors are thinking about levamisole.
Regards,
- By Kaif
- Posted October 25, 2009 at 3:52 am
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SJaved,
One thing i could not understand is that, if he is on high dose eg. 40mg or 20 mg he will respond well and he will never get cold or cough. But when we will down to 10 or 5 mg all of suden he will get cold or cough and trigered to relapse. I realy appriciate if any one can help me to understand to prevent Cold/Cough flu on low dose of pred.
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