Magdy Mohamed Zedan1, Ahmed El-Refaey2, Hosam Zaghloul3, Mohamed E A Abdelrahim4, Amal Osman5, Mohamed M Zedan2, Nashwa Eltantawy4. 1. Faculty of Medicine, Allergy, Respiratory and Clinical Immunology Unit, Pediatric Department, Mansoura University, Mansoura, Egypt. magdyzedan@yahoo.com. 2. Faculty of Medicine, Nephrology Unit, Pediatric Department, Mansoura University, Mansoura, Egypt. 3. Faculty of Medicine, Clinical Pathology Department, Mansoura University, Mansoura, Egypt. 4. Faculty of Pharmacy, Clinical Pharmacy Department, BeniSuef University, Benisuef, Egypt. 5. Faculty of Medicine, Allergy, Respiratory and Clinical Immunology Unit, Pediatric Department, Mansoura University, Mansoura, Egypt.
Abstract
BACKGROUND: The underlying mechanisms of nephrotic syndrome (NS) are still under debate and the need for more effective and less toxic treatment is challenging. We aimed to evaluate the efficacy of montelukast, a leukotriene receptor antagonist as an add-on therapy, and to explore the leukotriene (LT) biology in steroid-dependent nephrotic syndrome (SDNS). METHODS: A randomized controlled trial was conducted including 32 patients with SDNS who were randomly assigned to receive standard steroid treatment only [low-dose steroid (LDS) group] or standard steroid therapy plus montelukast (Montelukast group). Urine protein/creatinine ratio, serum albumin, creatinine, cholesterol, and plasma LTs (LTB4/C4/D4/E4) were evaluated in all patients before and after treatment. RESULTS: After treatment, both groups showed a significant decrease of LTB4 and LTC4/D4/E4. Further, the Montelukast group showed a significant decrease in serum creatinine and a significant increase in diastolic blood pressure and protein/creatinine ratio. It also showed a marked decrease in plasma LTC4/D4/E4 compared to the LDS group, although not statistically significant. CONCLUSIONS: Our findings highlight the effect of montelukast on renal function, but suggest that the clinical and laboratory efficacy of the addition of montelukast to steroids in maintenance treatment of SDNS is debatable.
RCT Entities:
BACKGROUND: The underlying mechanisms of nephrotic syndrome (NS) are still under debate and the need for more effective and less toxic treatment is challenging. We aimed to evaluate the efficacy of montelukast, a leukotriene receptor antagonist as an add-on therapy, and to explore the leukotriene (LT) biology in steroid-dependent nephrotic syndrome (SDNS). METHODS: A randomized controlled trial was conducted including 32 patients with SDNS who were randomly assigned to receive standard steroid treatment only [low-dose steroid (LDS) group] or standard steroid therapy plus montelukast (Montelukast group). Urine protein/creatinine ratio, serum albumin, creatinine, cholesterol, and plasma LTs (LTB4/C4/D4/E4) were evaluated in all patients before and after treatment. RESULTS: After treatment, both groups showed a significant decrease of LTB4 and LTC4/D4/E4. Further, the Montelukast group showed a significant decrease in serum creatinine and a significant increase in diastolic blood pressure and protein/creatinine ratio. It also showed a marked decrease in plasma LTC4/D4/E4 compared to the LDS group, although not statistically significant. CONCLUSIONS: Our findings highlight the effect of montelukast on renal function, but suggest that the clinical and laboratory efficacy of the addition of montelukast to steroids in maintenance treatment of SDNS is debatable.
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