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Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements.
Nephrol Dial Transplant 2005; 20(8):1598-603ND

Abstract

BACKGROUND

We previously have demonstrated that children with idiopathic nephrotic syndrome (INS) are at risk of metabolic bone disease (MBD). In this study, we report the longitudinal follow-up of these children and the role of calcium and vitamin D supplements.

METHODS

We prospectively studied 100 consecutive children with INS. They were treated with prednisone. All were subjected to a baseline clinical, biochemical and radiological evaluation. They were initiated on calcium (500 mg/day) and vitamin D3 (200 IU/day) supplements, followed by a repeat assessment. The primary outcome measure was the Deltaz score (difference between the initial and final z scores) on dual energy X-linked absorptiometry (DEXA). A univariate and multivariate analysis using stepwise linear regression was performed for factors predictive of an improved Deltaz score.

RESULTS

Of the 88 children that completed the study, the majority (n = 54) had improved bone mineral density (BMD) at the spine, and another 25 children had stable BMD on calcium and vitamin D3 supplements. The mean spinal BMD values were significantly better on follow-up (0.607+/-0.013 g/cm2) as compared with baseline values (0.561+/-0.010 g/cm2) (P<0.0001). The interval between initial and follow-up assessment was 1.5+/-0.07 years. Children who were on these supplements (n = 73) had a significantly improved z score as compared with those who did not receive them (n = 15) (P = 0.008). On multivariate analysis, the factors predictive of an improved z score were: younger age (P<0.0001), calcium and vitamin D3 supplement (P<0.0001), greater dietary calcium intake (P = 0.022) and lower interval steroid dose (P = 0.001).

CONCLUSIONS

Children with greater steroid doses were likely to have low BMD on follow-up. Calcium and vitamin D supplements may help in improving BMD in children with INS.

Authors+Show Affiliations

Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, India-226014. gulatis@mcmaster.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15956073

Citation

Gulati, Sanjeev, et al. "Longitudinal Follow-up of Bone Mineral Density in Children With Nephrotic Syndrome and the Role of Calcium and Vitamin D Supplements." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 20, no. 8, 2005, pp. 1598-603.
Gulati S, Sharma RK, Gulati K, et al. Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements. Nephrol Dial Transplant. 2005;20(8):1598-603.
Gulati, S., Sharma, R. K., Gulati, K., Singh, U., & Srivastava, A. (2005). Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 20(8), pp. 1598-603.
Gulati S, et al. Longitudinal Follow-up of Bone Mineral Density in Children With Nephrotic Syndrome and the Role of Calcium and Vitamin D Supplements. Nephrol Dial Transplant. 2005;20(8):1598-603. PubMed PMID: 15956073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements. AU - Gulati,Sanjeev, AU - Sharma,Raj K, AU - Gulati,Kiran, AU - Singh,Uttam, AU - Srivastava,Arvind, Y1 - 2005/06/14/ PY - 2005/6/16/pubmed PY - 2005/11/16/medline PY - 2005/6/16/entrez SP - 1598 EP - 603 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 20 IS - 8 N2 - BACKGROUND: We previously have demonstrated that children with idiopathic nephrotic syndrome (INS) are at risk of metabolic bone disease (MBD). In this study, we report the longitudinal follow-up of these children and the role of calcium and vitamin D supplements. METHODS: We prospectively studied 100 consecutive children with INS. They were treated with prednisone. All were subjected to a baseline clinical, biochemical and radiological evaluation. They were initiated on calcium (500 mg/day) and vitamin D3 (200 IU/day) supplements, followed by a repeat assessment. The primary outcome measure was the Deltaz score (difference between the initial and final z scores) on dual energy X-linked absorptiometry (DEXA). A univariate and multivariate analysis using stepwise linear regression was performed for factors predictive of an improved Deltaz score. RESULTS: Of the 88 children that completed the study, the majority (n = 54) had improved bone mineral density (BMD) at the spine, and another 25 children had stable BMD on calcium and vitamin D3 supplements. The mean spinal BMD values were significantly better on follow-up (0.607+/-0.013 g/cm2) as compared with baseline values (0.561+/-0.010 g/cm2) (P<0.0001). The interval between initial and follow-up assessment was 1.5+/-0.07 years. Children who were on these supplements (n = 73) had a significantly improved z score as compared with those who did not receive them (n = 15) (P = 0.008). On multivariate analysis, the factors predictive of an improved z score were: younger age (P<0.0001), calcium and vitamin D3 supplement (P<0.0001), greater dietary calcium intake (P = 0.022) and lower interval steroid dose (P = 0.001). CONCLUSIONS: Children with greater steroid doses were likely to have low BMD on follow-up. Calcium and vitamin D supplements may help in improving BMD in children with INS. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/15956073/Longitudinal_follow_up_of_bone_mineral_density_in_children_with_nephrotic_syndrome_and_the_role_of_calcium_and_vitamin_D_supplements_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfh809 DB - PRIME DP - Unbound Medicine ER -