Vitamin D level in nephrotic syndrome, Factors of impact?

Abstract

Introduction Nephrotic syndrome (NS) usually responds to steroid therapy; however, the majority of children relapse, resulting in prolonged and repeated courses of steroid therapy. Vitamin D is a vital component of bone metabolism and calcium homeostasis. Maintenance of adequate levels of vitamin D is recommended to maintain good bone health and other organ systems of NS patients. The study aimed to assess serum 25 (OH) D levels in children with NS, compare its level with healthy age and sex-matched controls and compare its level in different types of NS. Patients and Methods It was a cross-sectional study for measuring 25(OH) D levels in 60 patients with NS and 60 apparently healthy children, to be compared as controls. Nephrotic patients were classified as steroid sensitive (20 cases) steroid dependent (20cases), and steroid resistant (20 cases). Serum 25-hydroxyvitamin [25(OH) D] was measured using Enzyme Linked Immune Sorbent Assay (ELISA) technique. Results Serum 25(OH) D was significantly lower in NS patients than control group (p<0.001).Steroid resistant nephrotic syndrome (SRNS) patient group showed the highest drop than the other 2 groups (p<0.001). There was significant negative correlation between vitamin D level and number of relapses, 24 hours urinary proteins and serum cholesterol. Conclusion It is recommended that NS patients especially on long term steroid therapy should undergo regular follow up of vitamin D level and early prophylactic supplementation with calcium and vitamin D should be advised.

Evaluation of Biochemical Bone Markers in Children with Nephrotic Syndrome with Correlation to Its Severity

“…On pairwise comparison, the difference is significant between steroid-resistant anddependent, where steroid-resistant patients had lower vitamin D level followed by steroid-dependent then steroid-sensitive patients. This agrees with Marzouk et al (20) who reported that vitamin D was significantly lower in those with steroid-resistant NS. A crosssectional study done by Weng et al (10) who measured 25(OH) D in children with SRNS, SSNS and healthy controls and showed marked vitamin D deficiency in SRNS than SSNS and controls.…”

“…There was statistically significant difference between the case and control groups regarding serum vitamin D (Median level 13.6 ng/mL within case group versus 37.1 ng/mL within control group). This comes in harmony with a previous study by ElKersh et al (9) , Marzouk et al (20) , Nielsen et al (21) and Elsaeed et al (19) . Moreover, Selewski et al (5) reported that all children with NS at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2-4 months and that supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up supporting a role for supplementation in incident NS.…”

“…This can point to that relapse had a role in vitamin D deficiency. This partly agrees with Marzouk et al (20) and Banerjee et al (7) , where there was significant negative correlation between vitamin D and number of relapses. This partly agrees with a study conducted by Weng et al (10) who reported that number of relapses did not affect the concentration of 25 OH vitamin D. Whereas, in a study conducted by Biyikli et al (27) , there was a significant difference in 25 OH vitamin D levels between frequent relapsers and infrequent relapse, which is similar to our present study.…”

The Potential of Vitamin-D-Binding Protein as a Urinary Biomarker to Distinguish Steroid-Resistant from Steroid-Sensitive Idiopathic Nephrotic Syndrome in Iraqi Children

“…24,25 In children with NS, a greater extent of the decline in serum vitamin D level was noted in SRNS as compared to SSNS suggesting that the severity of uVDBP losses is more prominent in SRNS than in SSNS. [26][27][28] In that regard, the uVDBP levels were assessed in SRNS and SSNS patients from India and the United States (US) and significantly higher concentrations were reported in SRNS as compared to SSNS. 29,30 However, SSNS subjects with proteinuria on urinalysis showed a higher trend of uVDBP levels than that in SSNS cases without proteinuria.…”