Assessment of Biochemical measurements with vitamin D deficiency in nephrotic syndrome patient
DOI:
https://doi.org/10.53778/pjkd81247Keywords:
Nephrotic syndrome, vitamin D, deficiency, calcium, hypoalbuminemia, bone mineral metabolismAbstract
OBJECTIVE: To determine the frequency of vitamin D deficiency and bone mineral metabolism abnormalities in patients with nephrotic syndrome.
PATIENTS AND METHODS: Between June to December 2019, all patients who fulfilled the inclusion criteria and visited to SIUT, Karachi were included in the study, which is a descriptive cross sectional study. Informed consent was taken after explaining the procedure, risks and benefits of the study. Blood samples of all the patients were taken for measurement of vitamin D and bone mineral metabolism abnormalities.
RESULTS: Out of 92 patients, 51(55.4%) were male while 41 (44.6%) were female Mean ± SD of age was 32.76±10.16 years. Vitamin D deficiency was found in 49 (53.3%) patients. Hypocalcemia occurred in 48 (52.2%) patients. Raised Alkaline phosphate was found in 42 (45.7%) patients.
CONCLUSION: It is to be concluded that vitamin D deficiency and bone mineral metabolism abnormalities were documented in considerable number of patients presenting with nephrotic syndrome.
References
Geme JW, Schor NF, Behrman RE. Nelson textbook of pediatrics. Elsevier Health
Sciences; 2016.
Esmaeeili M, Azarfar A, Hoseinalizadeh S. Calcium and vitamin D metabolism in pediatric
nephrotic syndrome; an update on the existing literature. Int J Pediatr. 2015;3(2):103-9.
Banerjee S, Basu S, Sengupta J. Vitamin D in nephrotic syndrome remission: a case
control study. Pediatr, Nephrol. 2013;28(10):1983-9.
Subandiyah K, Khanifa H, Kardani AK. Effect of corticosteroid and vitamin D3 as
combined therapy on 25 (OH) vitamin D serum level and regulatory T (TReg) cells
population in children with idiopathic nephrotic syndrome. Bali Med J. 2018;7(3):639
Powe CE, Ricciardi C, Berg AH. Vitamin D-binding protein modifies the vitamin D-bone
mineral density relationship. J Bone Min Res. 2011;26(7):1609-16.
Nielsen CA, Jensen JE, Cortes D. Vitamin D status is insufficient in the majority of
children at diagnosis of nephrotic syndrome. Dan Med J. 2015;62(2):A5017.
Selewski DT, Chen A, Shatat IF, Pais P, Greenbaum LA, Geier P, et al. Vitamin D in
incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study.
Pediatr Nephrol. 2016;31(3):465-72.
Sheikh A, Saeed Z, Jafri SA, Yazdani I, Hussain SA. Vitamin D levels in asymptomatic
adults-a population survey in Karachi, Pakistan. Plos One. 2012;7(3):e33452.
Solanki JR, Sudhakaran S, Shringarpure KS. Prevalence of Vitamin D3 deficiency among
pediatric patients with idiopathic nephrotic syndrome in remission: a cross-sectional
observational study from Vadodara, Gujarat. Indian Child Health. 2018;5(7):481-3.
Yadav VK, Sharma S, Debata PK, Patel S, Kabi BC, Aggrawal KC. Change in bone mineral
density and role of Vitamin D and calcium supplementation during treatment of first
episode nephrotic syndrome. J Clin Diagn Res. 2017;11(9):SC18.
Khan AH, Iqbal R, Naureen G, Dar FJ, Ahmed FN. Prevalence of vitamin D deficiency and
its correlates: results of a community-based study conducted in Karachi, Pakistan. Arch
Osteoporos. 2012;7(1–2):275–82.
Iqbal R, Jafri L, Haroon A, Habib A. Illuminating the dark side-vitamin D status in
different localities of Karachi. J Coll Physicians Surg Pak. 2013;23(8):604-6.
Korkor A, Schwartz J, Bergfeld M, Teitelbaum S, Teitelbaum L, Klahr S, et al. Absence of
metabolic bone disease in adult patients with the nephrotic syndrome and normal renal
function. J Clin Endocrinol Metab. 1983;56(3):496-500.
Goldstein DA, Oda Y, Kurokawa K, Massry SG. Blood levels of 25-hydroxy vitamin D in
nephrotic syndrome. Studies in 26 patients. Ann Intern Med. 1977;87(6):664–7.
Shivanand I, Velagala SV, Sudhindrashayana RF. Study of prevalence of vitamin D
deficiency in nephrotic syndrome. Int J Contemp Pediatr. 2019;6(2).
Aggarwal A, Yadav AK, Ramachandran R, Kumar V, Kumar V, Sachdeva N, et al.
Bioavailable vitamin D levels are reduced and correlate with bone mineral density and
markers of mineral metabolism in adults with nephrotic syndrome. Nephrol.
;21(6):483-9.
Meguid El Nahas A, Bello AK. Chronic kidney disease: the global challenge. Lancet
;365:331–40.
Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition,
evaluation, and classification of renal osteodystrophy: a position statement from Kidney
Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006;69:1945–53.
Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of
abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic
kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71:
–8.
Al Zahrani A, Levine MA. Primary hyperparathyroidism. Lancet. 1997;349:1233-8.
Malluche HH, Goldstein DA, Massry SG. Osteomalacia and hyperparathyroid bone
disease in patients with nephrotic syndrome. J Gun Invest 1979;63:494-500
Goldstein DA, Oda Y, Kurokawa K, Massry SO. Blood level of 25-hydroxyvitamin-D in
nephrotic syndrome. Ann Intern Med 1977;87:664-7.
Tessitore N, BoNucci E, D'Angelo A, Lund B, Corgnati A, Lund B, et al. Bone histology and
calcium metabolism in patients with nephrotic syndrome and normal or reduced renal
function. Nephron 1984;37:153-9.
Freundlich M, Bourgoignie JJ, Zilleruelo G, Jacob Al, Canterbury JM, Strauss J. Bone
modulating factors in nephrotic children with normal glomerular filtration rate.
Pediatrics 1985;76:280-5.
Alon U, Chan JCM. Calcium and vitamin-D metabolism in nephrotic syndrome. J Pediatr
Nephrol 1983;4:115-8.
Nelson W, Kliegman R. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier; 2016.
Goldstein DA, Haldimann B, Sherman D, Norman AW, Massry SG. Vitamin D metabolites
and calcium metabolism in patients with nephrotic syndrome and normal renal function.
J Clin Endocrinol Metabol. 1981;52(1):116-21.
Bak M, Serdaroglu E, Guclu R. Prophylactic calcium and vitamin D treatments in steroid treated children with Nephrotic syndrome. Pediatr Nephrol. 2006;21:350-4.
Kinra S, Rath B, kabi B. Indirect quantification of lipid peroxidation in steroid responsive
nephrotic syndrome. Arch Dis Child. 2000;82:76-8.
Elsevier Clinical Advisory Board, Clinical Update: Nephrotic Syndrome. 2012.
Cunnane G, Lane NE. Steroid induced osteoporosis in systemic lupus erythematosus.
Rheum Dis North Am 2000;26:311-29.
Pitt P, Todd P, Webber D, Pack S, Moniz C. A double blind placebo controlled study to
determine the effects of intermittent cyclical etidronate on bone mineral density in
patients on long term oral corticosteroid treatment. Thorax 1998;53:351-6.
Sambrook PN. Inhaled corticosteroids, bone density and risk of fracture. Lancet
;355:9213.
Joshi U, Subedi R, Poudel P, Ghimire PR, Panta S, Sigdel MR. Assessment of quality of life
in patients undergoing hemodialysis using WHOQOL BREF questionnaire: a multicenter
study. Int J Nephrol Renovasc Dis. 2017;10:195-203.
Chauhan R, Mendonca S. Adequacy of twice weekly hemodialysis in end stage renal
disease patients at a tertiary care dialysis centre. Indian J Nephrol. 2015;25(6):329.
Cetin N, Gencler A, Sivrikoz IA. Bone mineral density and vitamin D status in children
with remission phase of steroid-sensitive nephrotic syndrome. Saudi J Kidney Dis
Transpl. 2019;30(4):853.
Bhan I, Dobens D, Tamez H, Deferio JJ, Li YC, Warren HS, et al. Nutritional vitamin D
supplementation in dialysis: a randomized trial. Clin J Am Soc Nephrol. 2015;10(4):611-
Erdem E. Proton pump inhibitors use in hemodialysis patients and serum magnesium
levels. Int J Clin Exp Med. 2015;8(11):21689.
Bansal B, Bansal S, Mithal A, Kher V, Marwaha R. Vitamin D deficiency in hemodialysis
patients. Indian J Endocrinol Metab. 2012;16(2):270.
Marquardt P, Krause R, Schaller M, Bach D, von Gersdorff G. Vitamin D status and cancer
prevalence of hemodialysis patients in germany Anticancer Res. 2015;35(2):1181-87.
Frost M, Abrahamsen B, Nielsen TL, Hagen C, Andersen M, Brixen K. Vitamin D status
and PTH in young men: A cross-sectional study on associations with bone mineral
density, body composition and glucose metabolism. Clin Endocrinol (Oxf) 2010;73:573-
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Kidney Diseases
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
