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Bioavailable Vitamin D Levels in Children With First Episode Nephrotic Syndrome: A Longitudinal Study
Sai Charan V1, Abhijeet Saha2, Rachita Singh Dhull1
1Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Children with first episode nephrotic syndrome (FENS) have vitamin D deficiency, with lower free and bioavailable vitamin D levels during the proteinuric phase. Levels improved after steroid therapy and remission.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Nutritional Science
Background:
- First episode nephrotic syndrome (FENS) is a common kidney disorder in children.
- Vitamin D deficiency is prevalent in various chronic conditions, potentially impacting FENS.
- Assessing bioavailable vitamin D is crucial for understanding its role in FENS.
Purpose of the Study:
- To measure serum bioavailable vitamin D in children with FENS at diagnosis and after treatment.
- To compare vitamin D levels in FENS patients with healthy controls.
- To evaluate changes in vitamin D status following steroid therapy in FENS remission.
Main Methods:
- Included children aged 1 month to 12 years with FENS.
- Measured serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D], parathormone, and vitamin D binding protein (VDBP).
- Estimated bioavailable and free 25(OH)D at diagnosis and after 4 weeks of steroid therapy; included healthy controls.
Main Results:
- Children with FENS showed lower mean 25(OH)D levels (11.3 ng/mL) compared to controls (16 ng/mL).
- Bioavailable vitamin D was significantly lower in FENS patients (0.58 ng/mL) versus controls (0.97 ng/mL), improving to 0.87 ng/mL in remission.
- Strong positive correlation found between free and bioavailable vitamin D (r=0.9); negative correlation between VDBP and bioavailable vitamin D (r=-0.69).
Conclusions:
- Children with FENS exhibit vitamin D deficiency.
- Reduced free and bioavailable vitamin D levels are characteristic of the proteinuric phase in FENS.
- Further research is needed to link bioavailable vitamin D and bone mineral density in pediatric nephrotic syndrome.
Objective:
To estimate the levels of serum bioavailable vitamin D in children presenting with first episode nephrotic syndrome (FENS) at diagnosis and after 4 weeks of standard steroid therapy while the child is in remission, and compare the same with age-sex matched healthy controls.
Methods:
We included children aged 1 month to 12 years presenting as FENS and estimated the serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D], parathormone, serum and urine vitamin D binding protein (VDBP) at diagnosis and after 4 weeks of standard steroid therapy while the child is in remission. We also included age-sex matched healthy controls for comparison. Bioavailable and free 25(OH)D were estimated at enrolment and at 4 weeks of therapy.
Results:
The mean (SD) 25(OH)D level (ng/mL) in children with FENS was 11.3 (6.1) at diagnosis and 13.6 (6.2) at 4 weeks follow-up, while the observed value in healthy controls was 16 (7) ng/mL. The median (IQR) serum VDBP level in FENS at enrolment was 223.0 (144, 305.5) µg/mL. There was significant correlation between serum VDBP and serum albumin levels (P = 0.04). At 4 weeks (remission), the median (IQR) VDBP levels increased to 554.5 (383, 644.75) µg/mL (P < 0.001). The median (IQR) free 25(OH)D levels (pg/mL) in children with FENS was 1.07 (0.8, 1.6) at enrolment and 0.53 (0.37, 0.86) at 4 weeks follow-up. The median (IQR) bioavailable vitamin D in FENS during proteinuria was 0.58 (0.4, 0.83) ng/ml, much lower as compared to controls 0.97 (0.85, 1.08) ng/mL (P < 0.001). On follow-up at 4 weeks of remission the median (IQR) bioavailable vitamin D levels increased to 0.87 (0.59, 1.42) ng/mL (P = 0.015). There was a very strong positive correlation between free vitamin D and bioavailable vitamin D (r = 0.9, P < 0.001); a strong negative correlation between serum VDBP and bioavailable vitamin D (r = - 0.69, P < 0.001). There was a positive correlation between 25 (OH)D and bioavailable vitamin D (r = 0.63, P < 0.001). Serum VDBP and serum albumin showed statistically significant positive correlation (r = 0.37, P < 0.05).
Conclusion:
Children with FENS are deficient in vitamin D. The free and bioavailable vitamin D levels are reduced in children with FENS during the proteinuric phase. Further studies to assess the association between bioavailable vitamin D and 25(OH)D with bone mineral density are needed in children with nephrotic syndrome to validate the utility of bioavailable vitamin D in clinical practice.
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