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Kidney Week

Abstract: PO1645

Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) for the Treatment of Pediatric Nephrotic Syndrome (NS)

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sethna, Christine B., Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, United States
  • Merchant, Kumail, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, United States
  • Zanos, Stavros, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, United States
  • Datta-Chaudhuri, Timir, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, United States
  • Singer, Pamela, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, United States
  • Castellanos, Laura J., Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, United States
  • Frank, Rachel, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, United States
Background

Children with NS, especially those with frequent relapses (FRNS) or steroid resistance (SRNS), are exposed to prolonged courses of immunosuppressant medications with side effects and variable efficacy. There is an urgent need to identify novel and safe therapies to treat pediatric NS. taVNS modulates the immune system via the cholinergic anti-inflammatory pathway and has become a therapy of interest for treating immune-mediated illnesses. The objective was to conduct an open-label early feasibility study of taVNS therapy for pediatric NS.

Methods

Children with FRNS (≥2 relapses in previous 6 months) or SRNS (no remission after 4 weeks of steroids) were enrolled. Participants with FRNS were in remission and off immunosuppression (off steroids >14 days and other immunosuppression >3 months). SRNS patients were on a stable regimen of medications for 6 months prior to enrollment. Participants performed taVNS therapy 5 minutes daily for 6 months with a TENS 7000 unit. taVNS was delivered to the auricular branch of the vagus nerve via the left cymba concha. Cytokine levels were compared using the Wilcoxon test.

Results

Seven participants (3 FRNS, 3 SRNS, 1 genetic congenital nephrotic syndrome [CNS]) had a median age of 7 years (range 3-17) and 63% were male. FRNS participants remained relapse-free during the study period (two continued taVNS at 9 and 13 months and remained in remission). SRNS participants had a 25-76% reduction in urine protein to creatinine ratio (upc) compared to baseline (Figure). Upc decreased (13.7%) in the participant with CNS but remained in nephrotic range. All but one participant (non-compliant) had a reduction in TNF-α (7.33pg/mL vs. 5.46pg/mL, p=0.03). No adverse effects were reported.

Conclusion

taVNS prevented NS relapses in FRNS, reduced proteinuria in SRNS, and reduced TNF-α levels without any adverse effects, suggesting taVNS as a promising therapy for pediatric NS. A larger, randomized clinical trial is needed to confirm these findings.