Randomized controlled trial on immunomodulatory effects of azithromycin in children with steroid-dependent nephrotic syndrome

• Published in: Pediatric nephrology (Berlin, West) West), 2019-09, Vol.34 (9), p.1591-1597
• Main Authors: Sawires, Happy, Abdelaziz, Hanan, Ahmed, Heba Mostafa, Botrous, Osama, Agban, Michael
• Format: Article
• Language: English
• Subjects: Antibiotics; Azithromycin; Children; Comparative analysis; Creatinine; Development and progression; Diagnosis; Diseases; Dosage and administration; Drug therapy; Immunomodulation; Inflammation; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Nephrotic syndrome; Original Article; Pediatrics; Prednisone; Remission; Steroid hormones; Steroids; Steroids (Drugs); Tumor necrosis factor-α; Urine; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-019-04251-5

Background Azithromycin (AZM) is a macrolide antibiotic with anti-inflammatory and immunomodulatory effects. Our aim was to compare the immunomodulatory effects of AZM combined with steroid therapy with that of steroid therapy alone in children with steroid-dependent nephrotic syndrome (SDNS). Methods We enrolled 57 patients with SDNS in a multicenter randomized control trial. Patients were classified into two groups: group A (intervention group, N  = 29) and group B (control group, N  = 28). After achievement of remission with full-dose daily prednisone, patients in group A received AZM in conjunction with steroids which was tapered gradually, while patients in group B received steroids alone. Urine protein creatinine ratio (uPCR) and TNF-α were measured at different points of follow-up throughout the study period (5 months after achieving remission). Results After achievement of remission by full-dose steroids, there were significant differences of TNF-α between the two groups after 1-, 3- and 5-month follow-up ( p