Diethylcarbamazine (DEC) in Relapse Cases of Nephrotic Syndrome in Filarial Endemic Region: A Case Series

Introduction: Incidence of nephrotic syndrome (NS) and filariasis both is high in China, Japan & India. Studies have shown the association of filariasis in NS. In the coastal belt of Gujarat, Filariasis occurs as the mosquito responsible is still prevalent. Therefore, filariasis association may be causing persistence of oedema in NS relapse cases. After a 7th relapse patient was treated successfully with diethylcarbamazine citrate (DEC), we decided to observe the effect of DEC on weight loss and urine protein, in relapse patients of NS.

Case Details: In relapse patients of NS, DEC was given by oral route in the dose of 72 mg/kg/cycle for 7 days. Weight record and urine protein were measured daily. Steroid as Tab prednisolone was administered at 2 mg/k/d.

Outcome: The 1st case was a steroid-dependent nephrotic syndrome with the 7th relapse; she had been on prednisolone and Levamisol for 3 years. DEC was started on day 3 of admission and response was seen on the 5th day. Urinary protein became nil on day 10, and the patient has been relapse free for 1 year. In each of the other 4 cases with 1st, 2nd, 2nd and 4th relapse respectively, the response of DEC was seen within 2 days. Thus, after starting DEC weight and urine protein reduced within 2 days in 5 relapse cases. Filaria was not detected in blood film of any patient and Elisa tests done in 2 were negative.

Conclusion: Randomized studies with controls and better filarial detection methods are required for DEC to be considered as an add-on drug in relapse cases of NS in, Filarial endemic regions, as it is faster acting, effective, similar to Levamisol and safe.