Evaluation of bone and mineral metabolism in primary corticosteroid-sensitive pediatric nephrotic syndrome

  • Miguel Liern Servicio de Nefrología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires
  • Mario Alejandro Mullet Mendoza Servicio de Nefrología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires
  • Carlos Alberto Manotas Arciniegas Servicio de Nefrología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires
  • Graciela Vallejo Servicio de Nefrología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires
Keywords: nephrotic syndrome, vitamin D, steroids, mineral metabolism, child, adolescent

Abstract

Introduction: Steroid treatment for corticosteroid-sensitive nephrotic syndrome (CSNS) could cause bone and mineral metabolism alterations, preventable with calcium and Vitamin D. Objectives: We carried out a preliminary retrospective study along 36 months with the following objectives. 1) To evaluate the relationship between Cumulative Corticosteroid Doses (CCD) and 25-0 Vitamin D serum concentration and with Bone Mineral Content (BMC); 2) To evaluate the relationship between CCD and Bone Mineral Densitomety (BMD). Methods: We included patients between 2 and 12 years of age with corticosteroid sensitive primary nephrotic syndrome (CSNS) (first episode, relapsing nephrotic syndrome, corticosteroid dependent nephrotic syndrome) normotensive, eutrophic and FG>:90ml/min/1.73 m2, who were divided into three groups: GROUP A: =3 or <relapses/year, GROUP B: >4 relapses/year, GROUP C: CSNS, we measured: a) Quarterly: calcemia, phosphatemia, alkaline phosphatase; b) half-yearly: 25-OH cholecalcipherol levels, CCD; c) annually BMD in children >6 years (score Z and BMC), bone age, PTHi. Results: We evaluated 29 patients, average age: 4.4 years. The BMD was performed on 11 patients and there were no significant differences among the groups (p=0.08). No significant differences were seen between chronologic age and average bone age (p=0.3). Change in 25-OH cholecalcipherol levels due to the increase of ergocalcipherol dose was significant (T:32.4 Q:<0.001). There were significant correlation in the three groups, between Vitamin D dose and Vitamin D serum levels (Pearson correlation R=0.9), between CCD and 25 OH cholecalcipherol dose: (Pearson correlation R=0.62) and between CCD and BMC (Pearson correlation R=0.44). Finally, in these three groups the average increase of vitamin D was: 1833IU. Conclusions: We found a relationship between CCD and hypovitaminosis D, which could be corrected increasing Vitamin D dose.

References

Freundlich M, Bourgoignie JJ, Zilleruelo G, Abitbol C, Canterbury JM, Strauss J. Calcium and vitamin D metabolism in children with nephrotic syndrome. J Pediatr. 1986;108(3):383-7.

Leonard MB. Glucocorticoid-induced osteoporosis in children: impact of the underlying disease. Pediatrics. 2007;119 Suppl 2:S166-74.

Koşan C, Ayar G, Orbak Z. Effects of steroid treatment on bone mineral metabolism in children with glucocorticoid-sensitive nephrotic syndrome. West Indian Med J. 2012;61(6):627-30.

Belostotsky V1, Mughal MZ, Berry JL, Webb NJ. Vitamin D deficiency in children with renal disease. Arch Dis Child. 2008;93(11):959-62.

Feber J, Gaboury I, Ni A, Alos N, Arora S, Bell L, et al. Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome. Osteoporos Int. 2012;23(2):751-60.

Wetzsteon RJ, Shults J, Zemel BS, Gupta PU, Burnham JM, Herskovitz RM, et al. Divergent effects of glucocorticoids on cortical and trabecular compartment BMD in childhood nephrotic syndrome. J Bone Miner Res. 2009;24(3):503-13.

Colston K, Williams NJ, Cleeve HJ. Studies on vitamin D binding protein in the nephrotic syndrome. Clin Chem. 1985;31(5):718-21.

Bak M, Serdaroglu E, Guclu R. Prophylactic calcium and vitamin D treatments in steroid-treated children with nephrotic syndrome. Pediatr Nephrol. 2006;21(3):350-4.

Rathi N, Rathi A. Vitamin D and child health in the 21st century. Indian Pediatr. 2011;48(8):619-25.

Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: an evidence-based review. J Am Board Fam Med. 2009;22(6):698-706.

Biyikli NK, Emre S, Sirin A, Bilge I. Biochemical bone markers in nephrotic children. Pediatr Nephrol. 2004;19(8):869-73.

Huang JP, Bai KM, Wang BL. Vitamin D and calcium metabolism in children with nephrotic syndrome of normal renal function. Chin Med J (Engl). 1992;105(10):828-32.

Comité de Nefrología, Sociedad Argentina de Pediatría. Consenso de tratamiento del sindrome nefrótico en la infancia. Arch Argent Pediatr. 2014;112(3):277-84.

Lombel RM, Gipson DS, Hodson EM. Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO. Pediatr Nephrol. 2013;28(3):415-26.

Papandreou D, Malindretos P, Karabouta Z, Rousso I. Possible Health Implications and Low Vitamin D Status during Childhood and Adolescence: An Updated Mini Review. Int J Endocrinol. 2010;2010:472173.

Mittal SK, Dash SC, Tiwari SC, Agarwal SK, Saxena S, Fishbane S. Bone histology in patients with nephrotic syndrome and normal renal function. Kidney Int. 1999;55(5):1912-9.

Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20(11):1807-20.

Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84(1):18-28.

Koşan C, Ayar G, Orbak Z. Effects of steroid treatment on bone mineral metabolism in children with glucocorticoid-sensitive nephrotic syndrome. West Indian Med J. 2012;61(6):627-30.

Canalis E. Clinical review 83: Mechanisms of glucocorticoid action in bone: implications to glucocorticoid-induced osteoporosis. J Clin Endocrinol Metab. 1996;81(10):3441-7.

Gordon CM, Baim S, Bianchi ML, Bishop NJ, Hans DB, Kalkwarf H, et al. Special report on the 2007 Pediatric Position Development Conference of the International Society for Clinical Densitometry. South Med J. 2008;101(7):740-3.

Bachrach LK. Osteoporosis and measurement of bone mass in children and adolescents. Endocrinol Metab Clin North Am. 2005;34(3):521-35, vii.

Leonard MB, Feldman HI, Shults J, Zemel BS, Foster BJ, Stallings VA. Long-term, high-dose glucocorticoids and bone mineral content in childhood glucocorticoid-sensitive nephrotic syndrome. N Engl J Med. 2004;351(9):868-75.

Hiraoka M, Tsukahara H, Matsubara K, Tsurusawa M, Takeda N, Haruki S, et al. A randomized study of two long-course prednisolone regimens for nephrotic syndrome in children. Am J Kidney Dis. 2003;41(6):1155-62.

Jayantha UK, et al. Prolonged versus standard steroid therapy for children with a relapsing course of nephrotic syndrome. Pediatr Nephrol 2004;19:c99.

Greenbaum LA, Benndorf R, Smoyer WE. Childhood nephrotic syndrome--current and future therapies. Nat Rev Nephrol. 2012;8(8):445-58.

Published
2017-04-22
How to Cite
1.
Liern M, Mullet Mendoza MA, Manotas Arciniegas CA, Vallejo G. Evaluation of bone and mineral metabolism in primary corticosteroid-sensitive pediatric nephrotic syndrome. Rev Nefrol Dial Traspl. [Internet]. 2017Apr.22 [cited 2024Nov.23];35(3):126-33. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/31
Issue
Vol. 35 No. 3 (2015): Jul.-Sept.
Section
Original Article