Vitamin D metabolite profiles in moderate renal insufficiency of childhood.

In a prior study, we reported vitamin D metabolite profiles in the plasma of healthy children. In view of these findings, we investigated these same profiles in children with moderate renal insufficiency. Specimens were obtained in both summer and winter in untreated patients, and before and after treatment for up to 1 year, with either 25(OH)D3 or 1,25(OH)2D3. Mean pretreatment 1,25(OH)2D levels were normal. Levels of 25(OH)D3 were also normal and continued to vary with season. Mean pretreatment 24,25(OH)2D3 levels were significantly lower in patients and, interestingly, did not show the normal seasonal variation. Treatment with 25(OH)D3 resulted in consistent and sustained rises in 25(OH)D3 and 24,25(OH)2D3 levels, but no increase in 1,25(OH)2D levels. After 1,25(OH)2D3 treatment, 25(OH)D3 levels were unchanged but still showed seasonal variation in some patients, suggesting a lack of feedback control by 1,25(OH)2D3. Levels of 24,25(OH)2D3 were not significantly different from baseline values. Levels of 1,25(OH)2D increased initially then dropped to pretreatment levels or lower. Normal 1,25(OH)2D levels and reduced 24,25(OH)2D3 levels with the loss of seasonal variation suggests in our patients that the kidney was able to maintain 1,25(OH)2D levels at the expense of 24,25(OH)2D3 levels, presumably to preserve calcium homeostasis.