David T Selewski1, Ashton Chen2, Ibrahim F Shatat3,4, Priya Pais5, Larry A Greenbaum6, Pavel Geier7, Raoul D Nelson8, Stefan G Kiessling9, Patrick D Brophy10, Alejandro Quiroga11, Michael E Seifert12,13, Caroline E Straatmann14, John D Mahan15, Maria E Ferris16, Jonathan P Troost17, Debbie S Gipson17. 1. Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA. dselewsk@med.umich.edu. 2. Department of Pediatrics, Section of Pediatric Nephrology, Wake Forest Baptist Health, Winston-Salem, NC, USA. 3. Division of Pediatric Nephrology and Hypertension, Sidra Medical and Research Center, Doha, Qatar. 4. Medical University of South Carolina, Charleston, SC, USA. 5. Department of Pediatric Nephrology, St. John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India. 6. Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA. 7. Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. 8. Division of Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. 9. Department of Pediatrics, University of Kentucky, Lexington, KY, USA. 10. Stead Family Department of Pediatrics, Division of Nephrology, University of Iowa, Iowa City, IA, USA. 11. DeVos Children's Hospital, Grand Rapids, MI, USA. 12. Division of Pediatric Nephrology, Department of Pediatrics, Washington University at St. Louis, St. Louis, MO, USA. 13. Department of Pediatrics, Southern Illinois University, Springfield, IL, USA. 14. Department of Pediatrics, Louisiana State University and Children's Hospital, New Orleans, LA, USA. 15. Nationwide Children's Hospital, The Ohio State University, College of Medicine, Columbus, OH, USA. 16. Pediatric Nephrology, UNC Kidney Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 17. Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20-100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. METHODS: Multicenter longitudinal study of children (2-18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. RESULTS: Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p < 0.01) in children supplemented with vitamin D. CONCLUSIONS: In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2-4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.
BACKGROUND: Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20-100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. METHODS: Multicenter longitudinal study of children (2-18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. RESULTS: Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p < 0.01) in children supplemented with vitamin D. CONCLUSIONS: In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2-4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.
Entities:
Keywords:
25(OH)D deficiency; Children; Nephrotic syndrome; Pediatric; Vitamin D
Authors: Debbie S Gipson; Susan F Massengill; Lynne Yao; Shashi Nagaraj; William E Smoyer; John D Mahan; Delbert Wigfall; Paul Miles; Leslie Powell; Jen-Jar Lin; Howard Trachtman; Larry A Greenbaum Journal: Pediatrics Date: 2009-07-27 Impact factor: 7.124
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