Skip to main content
Top
Published in: Pediatric Nephrology 1/2005

01-01-2005 | Original Article

Vitamin D insufficiency in steroid-sensitive nephrotic syndrome in remission

Authors: Francis L. Weng, Justine Shults, Rita M. Herskovitz, Babette S. Zemel, Mary B. Leonard

Published in: Pediatric Nephrology | Issue 1/2005

Login to get access

Abstract

Serum 25-hydroxyvitamin D [25(OH)D] concentrations are the best indicator of vitamin D nutritional status. We measured serum 25(OH)D concentrations in 94 healthy controls and in 41 subjects (aged 4–22 years) with steroid-sensitive nephrotic syndrome (SSNS) in remission. Children with remitted SSNS had significantly lower 25(OH)D concentrations than healthy controls (median 16.4 ng/ml versus 23.9 ng/ml, P <0.001). In a multivariable logistic regression model, the odds ratios (OR) of vitamin D insufficiency [25(OH)D <20 ng/ml] were independently increased in SSNS subjects [OR 11.2 (95% confidence interval 3.5–36.2)], non-whites [OR 12.9 (4.6–36.2)], older children [OR 1.20 per year (1.06–1.36)], and winter months [OR 6.7 (2.5–18.4)]. Within the SSNS subjects, multiple linear regression determined that serum 25(OH)D concentrations were not associated with SSNS disease characteristics measured in this study, such as duration of disease, number of relapses, cumulative glucocorticoids, and interval since last relapse. In conclusion, children with remitted SSNS have lower serum 25(OH)D concentrations than healthy controls. This difference persisted after adjusting for the potential confounding effects of age, race, season, and milk intake. Children with remitted SSNS may benefit from routine measurement of 25(OH)D, but the clinical significance of low 25(OH)D in this population remains unclear.
Literature
1.
go back to reference Alon U, Chan JC (1984) Calcium and vitamin D homeostasis in the nephrotic syndrome: current status. Nephron 36:1–4PubMed Alon U, Chan JC (1984) Calcium and vitamin D homeostasis in the nephrotic syndrome: current status. Nephron 36:1–4PubMed
2.
go back to reference Auwerx J, De Keyser L, Bouillon R, De Moor P (1986) Decreased free 1,25-dihydroxycholecalciferol index in patients with the nephrotic syndrome. Nephron 42:231–235PubMed Auwerx J, De Keyser L, Bouillon R, De Moor P (1986) Decreased free 1,25-dihydroxycholecalciferol index in patients with the nephrotic syndrome. Nephron 42:231–235PubMed
3.
go back to reference Grymonprez A, Proesmans W, Van Dyck M, Jans I, Goos G, Bouillon R (1995) Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol 9:278–281PubMed Grymonprez A, Proesmans W, Van Dyck M, Jans I, Goos G, Bouillon R (1995) Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol 9:278–281PubMed
4.
go back to reference Freundlich M, Bourgoignie JJ, Zilleruelo G, Jacob AI, Canterbury JM, Strauss J (1985) Bone modulating factors in nephrotic children with normal glomerular filtration rate. Pediatrics 76:280–285PubMed Freundlich M, Bourgoignie JJ, Zilleruelo G, Jacob AI, Canterbury JM, Strauss J (1985) Bone modulating factors in nephrotic children with normal glomerular filtration rate. Pediatrics 76:280–285PubMed
5.
go back to reference Freundlich M, Bourgoignie JJ, Zilleruelo G, Abitbol C, Canterbury JM, Strauss J (1986) Calcium and vitamin D metabolism in children with nephrotic syndrome. J Pediatr 108:383–387PubMed Freundlich M, Bourgoignie JJ, Zilleruelo G, Abitbol C, Canterbury JM, Strauss J (1986) Calcium and vitamin D metabolism in children with nephrotic syndrome. J Pediatr 108:383–387PubMed
6.
go back to reference Huang JP, Bai KM, Wang BL (1992) Vitamin D and calcium metabolism in children with nephrotic syndrome of normal renal function. Chin Med J (Engl) 105:828–832 Huang JP, Bai KM, Wang BL (1992) Vitamin D and calcium metabolism in children with nephrotic syndrome of normal renal function. Chin Med J (Engl) 105:828–832
7.
go back to reference Hollis BW (1996) Assessment of vitamin D nutritional and hormonal status: what to measure and how to do it. Calcif Tissue Int 58:4–5CrossRefPubMed Hollis BW (1996) Assessment of vitamin D nutritional and hormonal status: what to measure and how to do it. Calcif Tissue Int 58:4–5CrossRefPubMed
8.
go back to reference Barragry JM, France MW, Carter ND, Auton JA, Beer M, Boucher BJ, Cohen RD (1977) Vitamin-D metabolism in nephrotic syndrome. Lancet II:629–632CrossRef Barragry JM, France MW, Carter ND, Auton JA, Beer M, Boucher BJ, Cohen RD (1977) Vitamin-D metabolism in nephrotic syndrome. Lancet II:629–632CrossRef
9.
go back to reference Goldstein DA, Haldimann B, Sherman D, Norman AW, Massry SG (1981) Vitamin D metabolites and calcium metabolism in patients with nephrotic syndrome and normal renal function. J Clin Endocrinol Metab 52:116–121PubMed Goldstein DA, Haldimann B, Sherman D, Norman AW, Massry SG (1981) Vitamin D metabolites and calcium metabolism in patients with nephrotic syndrome and normal renal function. J Clin Endocrinol Metab 52:116–121PubMed
10.
go back to reference Malluche HH, Goldstein DA, Massry SG (1979) Osteomalacia and hyperparathyroid bone disease in patients with nephrotic syndrome. J Clin Invest 63:494–500PubMed Malluche HH, Goldstein DA, Massry SG (1979) Osteomalacia and hyperparathyroid bone disease in patients with nephrotic syndrome. J Clin Invest 63:494–500PubMed
11.
go back to reference Mittal SK, Dash SC, Tiwari SC, Agarwal SK, Saxena S, Fishbane S (1999) Bone histology in patients with nephrotic syndrome and normal renal function. Kidney Int 55:1912–1919CrossRefPubMed Mittal SK, Dash SC, Tiwari SC, Agarwal SK, Saxena S, Fishbane S (1999) Bone histology in patients with nephrotic syndrome and normal renal function. Kidney Int 55:1912–1919CrossRefPubMed
12.
go back to reference Tessitore N, Bonucci E, D’Angelo A, Lund B, Corgnati A, Valvo E, Lupo A, Loschiavo C, Fabris A, et al. (1984) Bone histology and calcium metabolism in patients with nephrotic syndrome and normal or reduced renal function. Nephron 37:153–159PubMed Tessitore N, Bonucci E, D’Angelo A, Lund B, Corgnati A, Valvo E, Lupo A, Loschiavo C, Fabris A, et al. (1984) Bone histology and calcium metabolism in patients with nephrotic syndrome and normal or reduced renal function. Nephron 37:153–159PubMed
13.
go back to reference Freundlich M, Jofe M, Goodman WG, Salusky IB (2004) Bone histology in steroid-treated children with non-azotemic nephrotic syndrome. Pediatr Nephrol 19:400–407CrossRefPubMed Freundlich M, Jofe M, Goodman WG, Salusky IB (2004) Bone histology in steroid-treated children with non-azotemic nephrotic syndrome. Pediatr Nephrol 19:400–407CrossRefPubMed
15.
go back to reference Alon US (1995) Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol 9:791–792PubMed Alon US (1995) Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol 9:791–792PubMed
16.
go back to reference National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42:S1–S202 National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42:S1–S202
17.
go back to reference International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. J Pediatr 98:561–564PubMed International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. J Pediatr 98:561–564PubMed
18.
go back to reference Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMed Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMed
19.
go back to reference Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60CrossRefPubMed Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60CrossRefPubMed
20.
go back to reference Hollis BW, Kamerud JQ, Selvaag SR, Lorenz JD, Napoli JL (1993) Determination of vitamin D status by radioimmunoassay with an125I-labeled tracer. Clin Chem 39:529–533PubMed Hollis BW, Kamerud JQ, Selvaag SR, Lorenz JD, Napoli JL (1993) Determination of vitamin D status by radioimmunoassay with an125I-labeled tracer. Clin Chem 39:529–533PubMed
21.
go back to reference Hollis BW, Kamerud JQ, Kurkowski A, Beaulieu J, Napoli JL (1996) Quantification of circulating 1,25-dihydroxyvitamin D by radioimmunoassay with125I-labeled tracer. Clin Chem 42:586–592PubMed Hollis BW, Kamerud JQ, Kurkowski A, Beaulieu J, Napoli JL (1996) Quantification of circulating 1,25-dihydroxyvitamin D by radioimmunoassay with125I-labeled tracer. Clin Chem 42:586–592PubMed
22.
go back to reference Bouillon R, Coopmans W, Degroote DE, Radoux D, Eliard PH (1990) Immunoradiometric assay of parathyrin with polyclonal and monoclonal region-specific antibodies. Clin Chem 36:271–276PubMed Bouillon R, Coopmans W, Degroote DE, Radoux D, Eliard PH (1990) Immunoradiometric assay of parathyrin with polyclonal and monoclonal region-specific antibodies. Clin Chem 36:271–276PubMed
23.
go back to reference Guillemant J, Cabrol S, Allemandou A, Peres G, Guillemant S (1995) Vitamin D-dependent seasonal variation of PTH in growing male adolescents. Bone 17:513–516CrossRefPubMed Guillemant J, Cabrol S, Allemandou A, Peres G, Guillemant S (1995) Vitamin D-dependent seasonal variation of PTH in growing male adolescents. Bone 17:513–516CrossRefPubMed
24.
go back to reference Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378PubMed Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378PubMed
25.
go back to reference Cannata-Andia JB, Gomez Alonso C (2002) Vitamin D deficiency: a neglected aspect of disturbed calcium metabolism in renal failure. Nephrol Dial Transplant 17:1875–1878CrossRefPubMed Cannata-Andia JB, Gomez Alonso C (2002) Vitamin D deficiency: a neglected aspect of disturbed calcium metabolism in renal failure. Nephrol Dial Transplant 17:1875–1878CrossRefPubMed
26.
go back to reference McKenna MJ, Freaney R (1998) Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D. Osteoporos Int 8 [Suppl 2]:S3–S6 McKenna MJ, Freaney R (1998) Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D. Osteoporos Int 8 [Suppl 2]:S3–S6
27.
go back to reference Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd ed. Wiley, New York, pp 91–202 Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd ed. Wiley, New York, pp 91–202
28.
go back to reference Sun GW, Shook TL, Kay GL (1996) Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 49:907–916CrossRefPubMed Sun GW, Shook TL, Kay GL (1996) Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 49:907–916CrossRefPubMed
29.
go back to reference Sherbotle JR, Hoyer JR (1991) Idiopathic nephrotic syndrome: minimal-change disease and focal segmental glomerulosclerosis. In: Jacobson HB, Striker GE, Klahr S (eds) The principles and practice of nephrology. Decker, Philadelphia, pp 288–292 Sherbotle JR, Hoyer JR (1991) Idiopathic nephrotic syndrome: minimal-change disease and focal segmental glomerulosclerosis. In: Jacobson HB, Striker GE, Klahr S (eds) The principles and practice of nephrology. Decker, Philadelphia, pp 288–292
30.
go back to reference Arbeitsgemeinschaft fur Padiatrische Nephrologie (1988) Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet I:380–383 Arbeitsgemeinschaft fur Padiatrische Nephrologie (1988) Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet I:380–383
31.
go back to reference Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64:1165–1168PubMed Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64:1165–1168PubMed
32.
go back to reference Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF (1992) Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 75:1099–1103CrossRefPubMed Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF (1992) Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 75:1099–1103CrossRefPubMed
33.
go back to reference Nesby-O’Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA (2002) Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76:187–192PubMed Nesby-O’Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA (2002) Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76:187–192PubMed
34.
go back to reference Gessner BD, Plotnik J, Muth PT (2003) 25-Hydroxyvitamin D levels among healthy children in Alaska. J Pediatr 143:434–437CrossRefPubMed Gessner BD, Plotnik J, Muth PT (2003) 25-Hydroxyvitamin D levels among healthy children in Alaska. J Pediatr 143:434–437CrossRefPubMed
35.
go back to reference Shaw NJ, Pal BR (2002) Vitamin D deficiency in UK Asian families: activating a new concern. Arch Dis Child 86:147–149CrossRefPubMed Shaw NJ, Pal BR (2002) Vitamin D deficiency in UK Asian families: activating a new concern. Arch Dis Child 86:147–149CrossRefPubMed
36.
go back to reference Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777CrossRefPubMed Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777CrossRefPubMed
37.
go back to reference Holick MF, Matsuoka LY, Wortsman J (1989) Age, vitamin D, and solar ultraviolet. Lancet II:1104–1105CrossRef Holick MF, Matsuoka LY, Wortsman J (1989) Age, vitamin D, and solar ultraviolet. Lancet II:1104–1105CrossRef
38.
go back to reference Cheng S, Tylavsky F, Kroger H, Karkkainen M, Lyytikainen A, Koistinen A, Mahonen A, Alen M, Halleen J, Vaananen K, Lamberg-Allardt C (2003) Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 78:485–492PubMed Cheng S, Tylavsky F, Kroger H, Karkkainen M, Lyytikainen A, Koistinen A, Mahonen A, Alen M, Halleen J, Vaananen K, Lamberg-Allardt C (2003) Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 78:485–492PubMed
39.
go back to reference Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158:531–537CrossRefPubMed Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158:531–537CrossRefPubMed
40.
41.
go back to reference Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD (1982) Vitamin D and bone health in the elderly. Am J Clin Nutr 36:1014–1031PubMed Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD (1982) Vitamin D and bone health in the elderly. Am J Clin Nutr 36:1014–1031PubMed
42.
go back to reference Leonard MB, Feldman HI, Shults J, Zemel BS, Foster BJ, Stallings VA (2004) Long-term, high-dose glucocorticoids and bone mineral content in childhood glucocorticoid-sensitive nephrotic syndrome. N Engl J Med 351:868–875CrossRefPubMed Leonard MB, Feldman HI, Shults J, Zemel BS, Foster BJ, Stallings VA (2004) Long-term, high-dose glucocorticoids and bone mineral content in childhood glucocorticoid-sensitive nephrotic syndrome. N Engl J Med 351:868–875CrossRefPubMed
43.
go back to reference Holick MF (2004) Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 79:362–371PubMed Holick MF (2004) Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 79:362–371PubMed
Metadata
Title
Vitamin D insufficiency in steroid-sensitive nephrotic syndrome in remission
Authors
Francis L. Weng
Justine Shults
Rita M. Herskovitz
Babette S. Zemel
Mary B. Leonard
Publication date
01-01-2005
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 1/2005
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-004-1694-7

Other articles of this Issue 1/2005

Pediatric Nephrology 1/2005 Go to the issue