Zinc as a Supplement in Reduction of Relapses in Children with Nephrotic Syndrome.

Abstract

Introduction: 80% of plasma zinc (Zn) is bound to albumin which is lost in urine in nephrotic syndrome (NS) during relapse period. Zinc supplementation reduces mortality and morbidity, especially among children due to infectious diseases, as it also has immune-modulator effects. Aim of the study:To study the efficacy of zinc supplementation in reducing the relapse and infection rates in children with nephrotic syndrome. Methods: This observational prospective study was conducted at the pediatric nephrology clinic of our hospital. It comprised 40 patients with frequent relapsing and/or steroid dependent NS. The patients were divided into two groups, the first group received zinc supplements (zinc group) and the second group were maintained on their usual treatment without zinc supplementation (and served as a control group). Both received routine medical care of nephrotic syndrome, but zinc group received also oral zinc supplementation 10 mg/day for 6 months with doubling the dose during infection period and relapse time. Serum zinc was measured at the start and at the end of the study. Relapse rate, hospitalization rate, number of days of hospitalization, time of relapse, and investigations were compared before and after zinc supplementation. Results: There was low serum zinc level in most cases of frequently relapsing / or steroid dependent nephrotic syndrome. Oral zinc supplementation in FRNS/ or steroid dependent NS, improved serum zinc level by 22.72%, reduced relapse rate by 28% and reduced hospitalization days by 33.7%. Although there was no significant improvement as regards hospitalization rate and time of relapse, sustained remission occurred in 80% of patients of zinc group. Conclusion: Oral zinc supplementation in frequently relapsing and in steroid dependent nephrotic syndrome children is useful for reduction of relapse rate, hospital stay and for achieving sustained remission.