A study on vitamin d status in children with nephrotic syndrome

Abstract

Background& objectives: Children with idiopathic nephrotic syndrome (NS) often exhibit abnormal Vitamin D metabolism despite preserved renal function. Serum concentrations of 25-hydroxyvitamin D [calcidiol or 25(OH)D], the best marker of body vitamin D stores may be decreased in children with NS. In NS, suboptimal 25(OH)D concentrations may lead to secondary hyperparathyroidism and metabolic bone disease, notably osteomalacia. Hence our study is an attempt to measure 25(OH)D levels in children with nephrotic syndrome during relapse and remission. Methods: This case control study was conducted in the hospitals attached to Kamineni Institute of Medical Sciences, between November 2017 to May 2019. This study included 30 children with nephrotic syndrome aged between 1 & 14 years. Blood sample was collected for estimation of serum 25(OH)D, albumin, calcium, phosphorus, alkaline phosphatase and creatinine, twice, once in relapse and once in remission. In control group of 30 children same set of investigations were done only once. Results: In all the cases serum concentration of Vitamin D was reduced significantly during relapse (mean=12.09 ng/ml) and slightly improved during remission (mean=17.07 ng/ml). There was significant variation in serum calcium levels when relapse levels (mean=8.68 mg/dl) were compared with remission levels (mean=8.93 mg/dl). Serum albumin was low in all the cases during relapse (mean=3.05 g /dl) and normalised during remission (mean=4.01 g/dl). Levels of Serum Phosphate and Serum ALP did not shown significant variation both during relapse and remission when compared with controls. Interpretation & conclusion: Our study showed that there is deficiency of Vitamin D levels in cases of NS both during relapse and remission. Hence, we recommend that Vitamin D and Calcium be supplemented during the course of illness and also continued till their levels return to normal. We recommend prospective large scale multi-centric studies regarding the rationale of treatment of NS children with Vitamin D supplementation.